Provider Demographics
NPI:1669438776
Name:RICHARDS, THERESA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:JEAN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23921 STATE HWY 58
Mailing Address - Street 2:
Mailing Address - City:RICHLAND CENTER
Mailing Address - State:WI
Mailing Address - Zip Code:53581-6647
Mailing Address - Country:US
Mailing Address - Phone:608-585-2805
Mailing Address - Fax:
Practice Address - Street 1:710 N FERN ST
Practice Address - Street 2:
Practice Address - City:RICHLAND CENTER
Practice Address - State:WI
Practice Address - Zip Code:53581-1127
Practice Address - Country:US
Practice Address - Phone:608-647-7153
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38222100Medicaid