Provider Demographics
NPI:1659684314
Name:RICHARDSON, WILINEVAH
Entity Type:Individual
Prefix:
First Name:WILINEVAH
Middle Name:
Last Name:RICHARDSON
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 1:2530 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3300
Mailing Address - Country:US
Mailing Address - Phone:248-841-1017
Mailing Address - Fax:
Practice Address - Street 1:2530 CROOKS RD
Practice Address - Street 2:LAB SUITE 2
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3300
Practice Address - Country:US
Practice Address - Phone:248-841-1017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife