Organization
DIANE RICHARDSON NURSE PRACTITIONER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE RICHARDSON NP (OWNER)
(616) 235-2090
Entity
Organization
Contact information
Practice address
0141 PORT SHELDON RD, GRANDVILLE, MI 49418
(616) 235-2090
(616) 235-2099
Mailing address
PO BOX 1767, GRAND RAPIDS, MI 49501-1767
(616) 235-2090
(616) 235-2099
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704110245
MI
Other
Enumeration date
04/04/2007
Last updated
11/04/2014
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