Provider Demographics
NPI:1104275262
Name:RICHARDSON, RENEE
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HIDDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03603-4309
Mailing Address - Country:US
Mailing Address - Phone:603-306-3959
Mailing Address - Fax:
Practice Address - Street 1:244 HIDDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:NH
Practice Address - Zip Code:03603-4309
Practice Address - Country:US
Practice Address - Phone:603-306-3959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker