Provider Demographics
NPI:1114464120
Name:RICHARDSON, KATHERINE MARGRET (CPNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARGRET
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1680 ROUTE 23 STE 350
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7538
Mailing Address - Country:US
Mailing Address - Phone:973-521-9700
Mailing Address - Fax:
Practice Address - Street 1:1680 ROUTE 23 STE 350
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-7538
Practice Address - Country:US
Practice Address - Phone:973-521-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-28
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306563163W00000X
NJ26NR19645000163WP0200X
NJ26NJ00773100363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics