Provider Demographics
NPI:1699173583
Name:RICHARDSON, DONNA (CRNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35950-0203
Mailing Address - Country:US
Mailing Address - Phone:256-593-1234
Mailing Address - Fax:256-593-6781
Practice Address - Street 1:3442 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0203
Practice Address - Country:US
Practice Address - Phone:256-593-1234
Practice Address - Fax:256-593-6781
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-087331363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner