Provider Demographics
NPI:1528815057
Name:RICHARDS, MARCIA KATHERINE (MSN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:KATHERINE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:KATHERINE
Other - Last Name:DIETZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1735
Mailing Address - Country:US
Mailing Address - Phone:607-773-4230
Mailing Address - Fax:607-773-4137
Practice Address - Street 1:425 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1735
Practice Address - Country:US
Practice Address - Phone:607-773-4230
Practice Address - Fax:607-773-4137
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY464330163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent