Provider Demographics
NPI:1942287636
Name:RICHARDSON, SUSAN E (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:E
Other - Last Name:TIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3231 GLACIER HWY
Mailing Address - Street 2:PLANNED PARENTHOOD
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7842
Mailing Address - Country:US
Mailing Address - Phone:907-523-5025
Mailing Address - Fax:
Practice Address - Street 1:3231 GLACIER HWY
Practice Address - Street 2:PLANNED PARENTHOOD
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7842
Practice Address - Country:US
Practice Address - Phone:907-523-5025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309527163W00000X
CA1696363LF0000X
AK115598163W00000X
AK115599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18368ZMedicare UPIN