Organization
DERENDA RICHARDSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERENDA JOELLE RICHARDSON ND (OWNER, PHYSICIAN)
(360) 353-3822
Entity
Organization
Contact information
Practice address
1514 COMMERCE AVE, LONGVIEW, WA 98632-4102
(360) 353-3822
Mailing address
1514 COMMERCE AVE, LONGVIEW, WA 98632-4102
(360) 353-3822
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
NT00001372
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447269428
NPI TYPE 1
—
01
—
NT00001372
WA DEPT OF HEALTH LICENSE
WA
Enumeration date
06/25/2012
Last updated
06/25/2012
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