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General NPI Number Information
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NPI Number | 1528044492
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Entity Type | Individual
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Provider Name | MARY RICHARDSON NP
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Gender | Female
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 236 E WESTFIELD AVE
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City | ROSELLE PARK
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State | NJ
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Zip | 07204-2084
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Country | US
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Telephone | 908-620-1600
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Fax | 908-620-0220
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Provider Business Mailing Address
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Address Line | 236 E WESTFIELD AVE
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City | ROSELLE PARK
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State | NJ
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Zip | 07204-2084
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Country | US
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Telephone | 908-620-1600
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Fax | 908-620-0220
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NO08212600
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License Number State | NJ
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