Provider Demographics
NPI:1124074927
Name:NORTON, RICHARD D (NP)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:NORTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16455 MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3500
Mailing Address - Country:US
Mailing Address - Phone:760-947-2161
Mailing Address - Fax:760-947-3673
Practice Address - Street 1:16455 MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3500
Practice Address - Country:US
Practice Address - Phone:760-947-2161
Practice Address - Fax:760-947-3673
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX721664363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX721664OtherRN LIC. NO.
TXQ53725Medicare UPIN
TX721664OtherRN LIC. NO.
613536/GROUP PTANMedicare PIN