Provider Demographics
NPI:1316419534
Name:RICHMOND, MARIA THERESE (RN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:THERESE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:THERESE
Other - Last Name:WOGERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:911 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-8207
Mailing Address - Country:US
Mailing Address - Phone:715-459-4210
Mailing Address - Fax:
Practice Address - Street 1:911 CENTER ST
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-8207
Practice Address - Country:US
Practice Address - Phone:715-459-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI243238163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health