Provider Demographics
NPI:1164280939
Name:RICHARDSON, ANDREA (CFSD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CFSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 OREGON AVE APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1430
Mailing Address - Country:US
Mailing Address - Phone:314-669-5182
Mailing Address - Fax:
Practice Address - Street 1:2648 OREGON AVE APT A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1430
Practice Address - Country:US
Practice Address - Phone:314-669-5182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula