Individual
MARDELL C RICHMOND
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
939 CAROLINE ST, PORT ANGELES, WA 98362-3909
(360) 417-7000
Mailing address
939 CAROLINE ST, PORT ANGELES, WA 98362-3909
(360) 417-7000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP30004046
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1709RI
REGENCE BLUE SHIELD RIDER
—
05
—
9634247
—
WA
01
—
P00024604
RAILROAD MEDICARE
—
Enumeration date
03/14/2006
Last updated
07/08/2007
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