Individual
SANDRA K RICHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
93 CAMPUS AVE, LEWISTON, ME 04240-6030
(207) 777-8442
(207) 777-8425
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8950
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RNA83198
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430078696
RAILROAD MEDICARE
—
Enumeration date
11/01/2006
Last updated
08/25/2020
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