Provider Demographics
NPI:1700199320
Name:RICHARDSON, HAROLD WAYNE (DVM,MS)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:WAYNE
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:DVM,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 GHERTY LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7861
Mailing Address - Country:US
Mailing Address - Phone:715-386-7808
Mailing Address - Fax:715-386-0922
Practice Address - Street 1:752 GHERTY LN
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-7861
Practice Address - Country:US
Practice Address - Phone:715-386-7808
Practice Address - Fax:715-386-0922
Is Sole Proprietor?:No
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5831-50174M00000X
MN00705174M00000X
IL090.003101174M00000X
KS3509174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian