Provider Demographics
NPI:1265478507
Name:RICHARDSON, LORRAINE YVONNE (FNP/ANP)
Entity Type:Individual
Prefix:PROF
First Name:LORRAINE
Middle Name:YVONNE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP/ANP
Other - Prefix:PROF
Other - First Name:LORRAINE
Other - Middle Name:HOLIFIELD
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP/ANP
Mailing Address - Street 1:3016 DELAVAN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4612
Mailing Address - Country:US
Mailing Address - Phone:314-894-6606
Mailing Address - Fax:314-845-5073
Practice Address - Street 1:3016 DELAVAN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4612
Practice Address - Country:US
Practice Address - Phone:314-894-6606
Practice Address - Fax:314-845-5073
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO83266363LF0000X, 363LA2200X, 363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health