Provider Demographics
NPI:1508826447
Name:RICHARDS, LAURIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:HOGDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1600 W 22ND ST
Mailing Address - Street 2:PO BOX 5039
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5039
Mailing Address - Country:US
Mailing Address - Phone:605-951-7068
Mailing Address - Fax:
Practice Address - Street 1:1600 W 22ND ST
Practice Address - Street 2:5039
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1521
Practice Address - Country:US
Practice Address - Phone:605-312-1120
Practice Address - Fax:605-312-1154
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD85442080N0001X, 208000000X
WI470712080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34613100Medicaid