Provider Demographics
NPI:1558445486
Name:RICHMOND, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 WASHINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1068
Mailing Address - Country:US
Mailing Address - Phone:518-489-4704
Mailing Address - Fax:518-489-0512
Practice Address - Street 1:1365 WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1068
Practice Address - Country:US
Practice Address - Phone:518-489-4704
Practice Address - Fax:518-489-0512
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349918163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator