Individual
ANDREA RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4017 SMITH ST, FORT WAYNE, IN 46806-1801
(260) 342-3873
Mailing address
4017 SMITH ST, FORT WAYNE, IN 46806-1801
(260) 342-3873
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
1270070609
IN
Other
Enumeration date
06/05/2026
Last updated
06/05/2026
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