Provider Demographics
NPI:1346686672
Name:RICHARD, ELLEN L (RN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:RICHARD
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 1:4242 STUMBERG LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4956
Mailing Address - Country:US
Mailing Address - Phone:225-756-5007
Mailing Address - Fax:
Practice Address - Street 1:4242 STUMBERG LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4956
Practice Address - Country:US
Practice Address - Phone:225-756-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN075299163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse