Provider Demographics
NPI:1679261127
Name:RICHARDSON, BARBARA D (BS)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11063 W FAIRLANE AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2585
Mailing Address - Country:US
Mailing Address - Phone:414-446-8700
Mailing Address - Fax:
Practice Address - Street 1:11063 W FAIRLANE AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2585
Practice Address - Country:US
Practice Address - Phone:414-446-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIR263-0646-7799-03172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver