Individual
MRS. JANETTE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, AGCNS-BC
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 410, FORT WAYNE, IN 46845-0025
(260) 266-7856
(260) 266-5279
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71012028A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28182737A
RN INDIANA NURSING LICENSE
IN
Enumeration date
06/23/2021
Last updated
01/19/2023
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