Provider Demographics
NPI:1588964183
Name:RICHARDSON, CYNTHIA (RN, NP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36867 COOK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6064
Mailing Address - Country:US
Mailing Address - Phone:760-341-1999
Mailing Address - Fax:
Practice Address - Street 1:36867 COOK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6064
Practice Address - Country:US
Practice Address - Phone:760-341-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7849363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner