Provider Demographics
NPI:1063822864
Name:RICHARDSON, BARBARA A (PHMNP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:A
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:PHMNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-1320
Mailing Address - Country:US
Mailing Address - Phone:207-255-3400
Mailing Address - Fax:
Practice Address - Street 1:30 BOYNTON ST
Practice Address - Street 2:
Practice Address - City:EASTPORT
Practice Address - State:ME
Practice Address - Zip Code:04631-1306
Practice Address - Country:US
Practice Address - Phone:207-853-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER034068163W00000X
MECNP181034364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECNP181034OtherSTATE LICENSE
MER034068OtherRN