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NPI Code Detail

MEDICARE: RICHARDSON PSYCHIATRIC

MEDICARE: RICHARDSON PSYCHIATRIC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner
2363LP2300XPrimary Care Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11144639527OTHERBLUE CROSS BLUE SHIELD
21144639527OTHERCIGNA
31144639527OTHERAETNA

General Provider Information

NPI Number : 1982168407
Entity Type Code : Organization
Provider Name (Legal Business Name) : RICHARDSON PSYCHIATRIC
Provider Business Mailing Address
First Line : 5000 S EAST END AVE APT 8B
Second Line :
City : CHICAGO
State : IL
Zip : 60615-3173
Country : US
Telephone Number : 773-732-6427
Fax Number :
Provider Business Practice Location Address
First Line : 3660 N LAKE SHORE DR STE 201
Second Line :
City : CHICAGO
State : IL
Zip : 60613-5302
Country : US
Telephone Number : 773-599-9246
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : DR. ANDREW D RICHARDSON
Credential : DNP
Telephone Number : 773-732-6427
Provider Enumeration Date : 01/29/2019
Last Update Date : 01/29/2019

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Directions to “RICHARDSON PSYCHIATRIC ” Practice Location

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