Provider Demographics
NPI:1821061441
Name:RICHARDSON, ANNIE H (CNM)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:H
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2525 N 8TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8845
Mailing Address - Country:US
Mailing Address - Phone:970-241-4001
Mailing Address - Fax:970-242-4299
Practice Address - Street 1:2525 N 8TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8845
Practice Address - Country:US
Practice Address - Phone:970-241-4001
Practice Address - Fax:970-242-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO98312367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49734075Medicaid