Provider Demographics
NPI:1154559557
Name:RICHARDS, LISA CATHLEEN (IDMT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CATHLEEN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:149 HART ST
Mailing Address - Street 2:82 MDG/MDOS
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-3477
Mailing Address - Country:US
Mailing Address - Phone:940-676-1832
Mailing Address - Fax:940-676-0860
Practice Address - Street 1:149 HART ST
Practice Address - Street 2:82 MDG/MDOS
Practice Address - City:SHEPPARD AFB
Practice Address - State:TX
Practice Address - Zip Code:76311-3477
Practice Address - Country:US
Practice Address - Phone:940-676-1832
Practice Address - Fax:940-676-0860
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians