Provider Demographics
NPI:1376840371
Name:RICHARDS, ILONA GOCZA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ILONA
Middle Name:GOCZA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:ILONA
Other - Middle Name:
Other - Last Name:GOCZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:810 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-8201
Practice Address - Country:US
Practice Address - Phone:574-583-6543
Practice Address - Fax:574-583-9502
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003456A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000827487OtherANTHEM PROVIDE NUMBER
IN201022390Medicaid
INP01629391Medicare PIN
IN000000827487OtherANTHEM PROVIDE NUMBER