Provider Demographics
NPI:1710376918
Name:RICHARDSON, ALEXIS D
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ELK RIDGE
Mailing Address - State:UT
Mailing Address - Zip Code:84651-4531
Mailing Address - Country:US
Mailing Address - Phone:801-836-4161
Mailing Address - Fax:
Practice Address - Street 1:212 E OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:ELK RIDGE
Practice Address - State:UT
Practice Address - Zip Code:84651-4531
Practice Address - Country:US
Practice Address - Phone:801-836-4161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker