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General NPI Number Information
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NPI Number | 1306095187
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Entity Type | Individual
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Provider Name | JAN MARIE RICHARDS HIS
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Gender | Female
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 07/18/2013
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Provider Practice Location Address
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Address Line | 925 W VILLARD ST
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City | DICKINSON
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State | ND
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Zip | 58601-4843
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Country | US
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Telephone | 701-227-4403
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Fax | 701-483-4405
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Provider Business Mailing Address
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Address Line | 925 W VILLARD ST
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City | DICKINSON
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State | ND
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Zip | 58601-4843
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Country | US
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Telephone | 701-227-4403
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Fax | 701-483-4405
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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 | 2355A2700X
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Taxonomy Name | Audiology Assistant
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License Number | 200448
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 200448
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | H-0313
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License Number State | ND
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