Provider Information for 1174808885
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LAURA ELIZABETH RICHARDSON
Sex: Female
NPI: 1174808885
Last Updated: 2024-09-11
Certification Date: 2024-09-11
Certification Date: 2024-09-11
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1174808885 | ||||||||||||||||
| Enumeration Date | 2011-10-13 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 11813 BLACKEYED SUSAN DR RIVERVIEW, FL 33579-1106 United States Phone: | Fax: | ||||||||||||||||
| Primary Practice Address | 11813 BLACKEYED SUSAN DR RIVERVIEW, FL 33579-1106 United States Phone: 813-690-7444 | Fax: | ||||||||||||||||
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