Healthcare Provider Details

I. General information

NPI: 1205099579
Provider Name (Legal Business Name): ROBIN V RICHEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 100TH ST
FREDERIC WI
54837-5026
US

IV. Provider business mailing address

2707 100TH ST
FREDERIC WI
54837-5026
US

V. Phone/Fax

Practice location:
  • Phone: 715-472-8076
  • Fax: 715-472-4694
Mailing address:
  • Phone: 715-472-8076
  • Fax: 715-472-4694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number163761
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: