Provider Demographics
NPI:1700860046
Name:RICHARDSON, ELIZABETH DAMON (RNC/NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DAMON
Last Name:RICHARDSON
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Gender:F
Credentials:RNC/NP
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Mailing Address - Street 1:15027 MORNING PATH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3396
Mailing Address - Country:US
Mailing Address - Phone:210-916-5477
Mailing Address - Fax:210-916-5557
Practice Address - Street 1:3851 ROGER BROOKE DR
Practice Address - Street 2:MCHE-QD(CREDS)
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4501
Practice Address - Country:US
Practice Address - Phone:210-916-5477
Practice Address - Fax:210-916-1021
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-03-26
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Provider Licenses
StateLicense IDTaxonomies
TX251230363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health