Provider Demographics
NPI:1083658017
Name:RICHARDSON, ANTOINETTE (RD,CDE, LDN)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RD,CDE, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MEADOW VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3350
Mailing Address - Country:US
Mailing Address - Phone:610-539-2026
Mailing Address - Fax:610-539-2026
Practice Address - Street 1:1014 MEADOW VIEW CIR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3350
Practice Address - Country:US
Practice Address - Phone:610-539-2026
Practice Address - Fax:610-539-2026
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000256133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education