Organization
RICHARDSON PSYCHIATRIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW D RICHARDSON DNP (NURSE PRACTITIONER)
(773) 732-6427
Entity
Organization
Contact information
Practice address
3660 N LAKE SHORE DR STE 201, CHICAGO, IL 60613-5302
(773) 599-9246
Mailing address
5000 S EAST END AVE APT 8B, CHICAGO, IL 60615-3173
(773) 732-6427
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144639527
BLUE CROSS BLUE SHIELD
—
Enumeration date
01/29/2019
Last updated
01/29/2019
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