Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | ML60224535 | WA |
Y | 2080P0210X | Pediatric Nephrologist | MD182992 | OR |
NPI | 1477852259 |
---|---|
Provider Name | Kelsey Linde Richardson |
First Address | Portland, OR 97239 |
Second Address | Portland, OR 97239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2011 |
Last Update Date | 17/03/2018 |