MEDICARE: MICHELLE RICHARDSON

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	163WP0200X	Pediatric Registered Nurse	RN60687575	WA

General Provider Information

NPI Number	:	1710756119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE RICHARDSON

Provider Business Mailing Address
First Line	:	4118 S COOK ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-4425
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 S COOK ST
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99223-4425
Country	:	US
Telephone Number	:	509-816-2969
Fax Number	:

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

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	12/27/2023

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Directions to “ MICHELLE RICHARDSON ” Practice Location

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