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NPI Code Detail

MEDICARE: DORA L RICHARDSON RN, CNP

MEDICARE: DORA L RICHARDSON RN, CNP
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
1363L00000XNurse PractitionerNP04192OH

General Provider Information

NPI Number : 1922037332
Entity Type Code : Individual
Provider Name (Legal Business Name) : DORA L RICHARDSON RN, CNP
Provider Business Mailing Address
First Line : 6984 LAFAYETTE RD
Second Line :
City : MEDINA
State : OH
Zip : 44256-8580
Country : US
Telephone Number : 330-723-4048
Fax Number :
Provider Business Practice Location Address
First Line : 24165 DETROIT RD
Second Line :
City : WESTLAKE
State : OH
Zip : 44145-1516
Country : US
Telephone Number : 440-250-3560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 07/08/2007

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