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Individual

RICHARD L DERRICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-2526
Mailing address
735 S PEACHTREE DR, TOQUERVILLE, UT 84774-5079
(180) 166-4234
(770) 701-6675

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN9469329
FL
367500000X
Certified Registered Nurse Anesthetist
0024179084
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
9639260-4406
UT

Other

Enumeration date
02/12/2020
Last updated
12/18/2024
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