Provider Demographics
NPI:1720566797
Name:RICHESON, SARA EMMA
Entity Type:Individual
Prefix:MS
First Name:SARA
Middle Name:EMMA
Last Name:RICHESON
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 1:3800 VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8257
Mailing Address - Country:US
Mailing Address - Phone:812-477-6103
Mailing Address - Fax:812-477-4897
Practice Address - Street 1:3800 VENETIAN WAY
Practice Address - Street 2:STE 200
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8257
Practice Address - Country:US
Practice Address - Phone:812-266-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28223580A163W00000X
IN71008848A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse