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General NPI Number Information
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NPI Number | 1063520682
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Entity Type | Individual
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Provider Name | DONNA MARIE RICHARDSON NP
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2495 SHREVEPORT HWY 71 N
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City | PINEVILLE
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State | LA
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Zip | 71360-9004
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Country | US
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Telephone | 318-473-0010
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Fax | 318-483-5072
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Provider Business Mailing Address
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Address Line | PO BOX 17874
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City | NATCHEZ
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State | MS
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Zip | 39122-7874
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Country | US
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Telephone | 601-445-0907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 496863894
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License Number State | LA
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