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General NPI Number Information
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NPI Number | 1871414565
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Entity Type | Individual
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Provider Name | ADAM OTTO RICHARDSON
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Gender | Male
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Dates
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Enumeration Date | 07/21/2026
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Last Update Date | 07/21/2026
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Provider Practice Location Address
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Address Line | 9040A JACKSON AVE
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City | JOINT BASE LEWIS MCCHORD
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-0832
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Fax |
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Provider Business Mailing Address
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Address Line | 2188 IRISH VALLEY RD
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City | PAXINOS
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State | PA
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Zip | 17860-7365
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Country | US
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Telephone | 570-259-6279
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN735763
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License Number State | PA
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