Provider Demographics
NPI:1407892136
Name:RICHARDSON, LUANN G (CRNP)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:G
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 LEONARD AVE
Mailing Address - Street 2:BUILDING 1, SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3368
Mailing Address - Country:US
Mailing Address - Phone:724-579-1075
Mailing Address - Fax:724-579-1075
Practice Address - Street 1:95 LEONARD AVE
Practice Address - Street 2:BUILDING 1, SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-3368
Practice Address - Country:US
Practice Address - Phone:724-579-1075
Practice Address - Fax:724-579-1075
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP001343B363LA2200X
PANP012881363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA362219OtherKEYSTONE HEALTH PLAN WEST
PA362219OtherKEYSTONE HEALTH PLAN WEST
PA008671F2JMedicare ID - Type UnspecifiedMEDICARE