Individual
IDAHLIA ETHEL RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
1515 HOLCOMBE BLVD, HOUSTON, TX 77030-4009
(713) 792-6161
Mailing address
P O BOX 4439, HOUSTON, TX 77210-4439
(713) 792-2991
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
AP129798
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
359757701
—
TX
Enumeration date
04/04/2016
Last updated
09/08/2016
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