Individual
LAURENA DIANE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1661 HIGHWAY 99 N STE 100, ASHLAND, OR 97520-8900
(541) 732-8300
(541) 732-3411
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 732-8300
(541) 732-3411
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA207919
OR
363AS0400X
Surgical Physician Assistant
PA60997023
WA
Other
Enumeration date
10/17/2018
Last updated
01/05/2022
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