Provider Demographics
NPI:1164900742
Name:RICHARDS, GRACE (RN)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1129
Mailing Address - Country:US
Mailing Address - Phone:516-468-5335
Mailing Address - Fax:
Practice Address - Street 1:776 SOUTH DR
Practice Address - Street 2:
Practice Address - City:NORTH BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-1129
Practice Address - Country:US
Practice Address - Phone:516-468-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-05
Last Update Date:2018-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY506741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse