MEDICARE: MRS. ANARESIA MARIE RICHARD FNP

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	363LP2300X	Primary Care Nurse Practitioner	AP1692	AZ

General Provider Information

NPI Number	:	1821093477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANARESIA MARIE RICHARD FNP

Provider Business Mailing Address
First Line	:	10225 HARBOR AVE
Second Line	:	STE 5
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-9699
Country	:	US
Telephone Number	:	928-788-2373
Fax Number	:	928-788-2374

Provider Business Practice Location Address
First Line	:	10225 HARBOR AVE
Second Line	:	STE 5
City	:	MOHAVE VALLEY
State	:	AZ
Zip	:	86440-9699
Country	:	US
Telephone Number	:	928-788-2373
Fax Number	:	928-788-2374

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

Provider Enumeration Date	:	06/19/2005
Last Update Date	:	07/08/2007

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