Provider Demographics
NPI:1700829892
Name:RICHARDS, MARY L (RN MSN CANP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RN MSN CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 PARKWAY DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304
Mailing Address - Country:US
Mailing Address - Phone:503-375-6119
Mailing Address - Fax:
Practice Address - Street 1:885 MISSION ST SE
Practice Address - Street 2:SALEM CARDIOLOGY ASSOCIATES PC
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302
Practice Address - Country:US
Practice Address - Phone:503-585-5585
Practice Address - Fax:503-587-7823
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR083038222N3ANP363L00000X
OR163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
S59290Medicare UPIN
120949Medicare ID - Type Unspecified