Provider Demographics
NPI:1346535606
Name:RICHARDSON, LEA ANNA (RN)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ANNA
Last Name:RICHARDSON
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 1:600 NW 23RD ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73103-1469
Mailing Address - Country:US
Mailing Address - Phone:405-601-9610
Mailing Address - Fax:
Practice Address - Street 1:600 NW 23RD ST
Practice Address - Street 2:SUITE 108
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-1469
Practice Address - Country:US
Practice Address - Phone:405-601-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR60591163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse