Provider Demographics
NPI:1750834206
Name:RICHARDS, CAROLYN (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 RUDOLPH WAY
Mailing Address - Street 2:
Mailing Address - City:GREENDALE
Mailing Address - State:IN
Mailing Address - Zip Code:47025-8312
Mailing Address - Country:US
Mailing Address - Phone:812-537-1668
Mailing Address - Fax:812-537-0418
Practice Address - Street 1:816 RUDOLPH WAY
Practice Address - Street 2:
Practice Address - City:GREENDALE
Practice Address - State:IN
Practice Address - Zip Code:47025-8312
Practice Address - Country:US
Practice Address - Phone:812-537-1668
Practice Address - Fax:812-537-0418
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28190837A163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)