1285966168 NPI number — DONNA J RICHARDS CNM

Table of content: DONNA J RICHARDS CNM (NPI 1285966168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285966168 NPI number — DONNA J RICHARDS CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHARDS
Provider First Name:
DONNA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285966168
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4101 NW 4TH ST
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33317-2850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-522-2979
Provider Business Mailing Address Fax Number:
954-903-0633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 NW 4TH ST
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
PLANTATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33317-2850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-522-2979
Provider Business Practice Location Address Fax Number:
954-903-0633
Provider Enumeration Date:
02/03/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WX0003X , with the licence number:  ARNP1804772 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367A00000X , with the licence number: ARNP1804772 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 340169300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".