Provider Demographics
NPI:1194918052
Name:RICHARDSON, MICHELLE WILLIAMS (FNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:WILLIAMS
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 PICKARD RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4461
Mailing Address - Country:US
Mailing Address - Phone:910-332-0701
Mailing Address - Fax:910-332-0710
Practice Address - Street 1:2580 PICKARD RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4461
Practice Address - Country:US
Practice Address - Phone:910-332-0701
Practice Address - Fax:910-332-0710
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-03364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1194918052OtherNPI