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General NPI Number Information
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NPI Number | 1649866997
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Entity Type | Individual
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Provider Name | SUSAN M RICHARDS CNP
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Gender | Female
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 6709 S MINNESOTA AVE STE 102
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2593
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Country | US
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Telephone | 605-322-7259
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 312
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City | ALEXANDRIA
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State | SD
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Zip | 57311-0312
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Country | US
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Telephone | 605-212-7899
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CP001922
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License Number State | SD
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