Provider Demographics
NPI:1619119799
Name:RICHARDS, BETTY NAMAKULA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:NAMAKULA
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WAUSHAKUM ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8736
Mailing Address - Country:US
Mailing Address - Phone:781-308-7855
Mailing Address - Fax:508-620-6055
Practice Address - Street 1:65 WAUSHAKUM ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8736
Practice Address - Country:US
Practice Address - Phone:508-620-6055
Practice Address - Fax:508-620-6055
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN257128363LF0000X
GARN276341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty