Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | COA.10895-NP | OH |
NPI | 1043449457 |
---|---|
Provider Name | Stacie E. Richmond |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 01/05/2015 |