Provider Demographics
NPI:1073863825
Name:RICHARDSON, DEBORAH L (NP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 RIFLE RIVER TRL
Mailing Address - Street 2:
Mailing Address - City:ALGER
Mailing Address - State:MI
Mailing Address - Zip Code:48610-9343
Mailing Address - Country:US
Mailing Address - Phone:989-873-5323
Mailing Address - Fax:989-873-3673
Practice Address - Street 1:5170 RIFLE RIVER TRL
Practice Address - Street 2:
Practice Address - City:ALGER
Practice Address - State:MI
Practice Address - Zip Code:48610-9343
Practice Address - Country:US
Practice Address - Phone:989-873-5323
Practice Address - Fax:989-873-3673
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily