Provider Demographics
NPI:1346740081
Name:RICHARDSON, REBEKAH JOY (RN)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:JOY
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:N142W6300 CONCORD ST
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-3106
Mailing Address - Country:US
Mailing Address - Phone:414-899-4510
Mailing Address - Fax:
Practice Address - Street 1:N142W6300 CONCORD ST
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-3106
Practice Address - Country:US
Practice Address - Phone:414-899-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI184622-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse