Individual
COURTNEY B RICHTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13111 N PORT WASHINGTON RD, MEQUON, WI 53097
(414) 290-6720
(414) 290-6755
Mailing address
4466 WEILERS WAY, PORT WASHINGTON, WI 53074-9608
(208) 859-5606
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2069
WI
363A00000X
Physician Assistant
PA750
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447348545
—
WI
05
—
808128200
—
ID
Enumeration date
10/11/2006
Last updated
08/22/2022
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