Provider Demographics
NPI:1558779108
Name:RICHARDS, DEBORA G (RN BSN)
Entity Type:Individual
Prefix:
First Name:DEBORA
Middle Name:G
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 DUTCH FORK RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8822
Mailing Address - Country:US
Mailing Address - Phone:803-476-8000
Mailing Address - Fax:
Practice Address - Street 1:1020 DUTCH FORK RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8822
Practice Address - Country:US
Practice Address - Phone:803-476-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC138402163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC138402Medicaid