Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 83266 | MO |
N | 363LC1500X | Nurse Practitioner - Community Health | 83266 | MO |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 83266 | MO |
NPI | 1265478507 |
---|---|
Provider Name | Prof. Lorraine Yvonne Richardson |
First Address | Saint Louis, MO 63121-4612 |
Second Address | Saint Louis, MO 63121-4612 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 02/07/2015 |