Provider Demographics
NPI:1639155732
Name:RICHARDS, LISA E (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARE
Mailing Address - State:MI
Mailing Address - Zip Code:48617-9414
Mailing Address - Country:US
Mailing Address - Phone:989-386-9911
Mailing Address - Fax:989-386-9913
Practice Address - Street 1:700 W 5TH ST
Practice Address - Street 2:
Practice Address - City:CLARE
Practice Address - State:MI
Practice Address - Zip Code:48617-9414
Practice Address - Country:US
Practice Address - Phone:989-386-9911
Practice Address - Fax:989-386-9913
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004348363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ32203Medicare UPIN