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General NPI Number Information
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NPI Number | 1740058874
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Entity Type | Individual
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Provider Name | CHESTER JOSIAH RICHARDSON APRN
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Gender | Male
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 193 MAIN ST STE 14
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City | NORWAY
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State | ME
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Zip | 04268-5647
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Country | US
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Telephone | 207-294-7096
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Fax | 207-393-3470
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Provider Business Mailing Address
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Address Line | 32 WOODLAWN AVE
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City | PORTLAND
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State | ME
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Zip | 04103-3510
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Country | US
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Telephone | 207-249-9747
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP231412
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License Number State | ME
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