Provider Demographics
NPI:1417101312
Name:RICHARDSON, PATIENCE MALI (LMP)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:MALI
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10011 21ST AVE W APT A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-3665
Mailing Address - Country:US
Mailing Address - Phone:425-345-1162
Mailing Address - Fax:
Practice Address - Street 1:10011 21ST AVE W APT A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-3665
Practice Address - Country:US
Practice Address - Phone:425-345-1162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60037465225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist