Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 883 | AZ |
N | 213ES0103X | Foot & Ankle Surgery | E4998 | CA |
NPI | 1043579162 |
---|---|
Provider Name | Johanna-Marie Richey |
First Address | Yuma, AZ 85364-7154 |
Second Address | Yuma, AZ 85364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2012 |
Last Update Date | 19/04/2019 |