MEDICARE: MRS. MARY LAURA RICHARDSON MS, BA, RN, IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	1653683	CO

General Provider Information

NPI Number	:	1598461717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY LAURA RICHARDSON MS, BA, RN, IBCLC

Provider Business Mailing Address
First Line	:	5025 VISTA DEL SOL PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-8007
Country	:	US
Telephone Number	:	717-377-2568
Fax Number	:

Provider Business Practice Location Address
First Line	:	5025 VISTA DEL SOL PT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-8007
Country	:	US
Telephone Number	:	717-377-2568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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