Provider Demographics
NPI:1972088375
Name:RICHARDS, AMBER MICHELLE (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELLE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-1449
Mailing Address - Country:US
Mailing Address - Phone:580-304-9160
Mailing Address - Fax:580-262-4259
Practice Address - Street 1:3722 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1449
Practice Address - Country:US
Practice Address - Phone:580-304-9160
Practice Address - Fax:580-262-4259
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106022163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant