1740745579 NPI number — DANIELLE RICHMOND

Table of content: DANIELLE RICHMOND (NPI 1740745579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740745579 NPI number — DANIELLE RICHMOND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICHMOND
Provider First Name:
DANIELLE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1740745579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
771 EASTWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23236-2678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-968-7654
Provider Business Mailing Address Fax Number:
804-823-2746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 HALIFAX ST # 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMPORIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23847-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-233-4986
Provider Business Practice Location Address Fax Number:
804-823-2746
Provider Enumeration Date:
02/06/2019

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1 . This is a "MEDICAID" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com