Provider Demographics
NPI:1568563864
Name:RICHARDSON, LYNN ANN (RN, CNS)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:ANN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5637 BROOKLYN BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3081
Mailing Address - Country:US
Mailing Address - Phone:763-971-2959
Mailing Address - Fax:763-971-2959
Practice Address - Street 1:5637 BROOKLYN BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-3081
Practice Address - Country:US
Practice Address - Phone:763-971-2959
Practice Address - Fax:763-971-2959
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR0661711364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
5379824OtherCIGNA
6247871OtherUNITED BEHAVIORAL HEALTH
MN448255700Medicaid
17F32RIOtherBCBS
5379824OtherCIGNA
890000101Medicare ID - Type Unspecified