Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | CNP121059 | ME |
NPI | 1003162132 |
---|---|
Provider Name | Jessica Adelaide Richardson |
First Address | Turner, ME 04282-3528 |
Second Address | Oakland, ME 04963-5370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2012 |
Last Update Date | 31/08/2021 |