Provider Demographics
NPI:1528373628
Name:RICHARD, MARIE S (RN)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:S
Last Name:RICHARD
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 1:7863 EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13030-9405
Mailing Address - Country:US
Mailing Address - Phone:315-317-6684
Mailing Address - Fax:
Practice Address - Street 1:8235 TURNSTONE DR
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-2138
Practice Address - Country:US
Practice Address - Phone:315-263-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY544264163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience