Provider Demographics
NPI:1972817500
Name:RICHARDSON, COURTNEY MICHELE (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MICHELE
Last Name:RICHARDSON
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 1:2476 RAVENEL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-3307
Mailing Address - Country:US
Mailing Address - Phone:614-439-4650
Mailing Address - Fax:
Practice Address - Street 1:2476 RAVENEL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-3307
Practice Address - Country:US
Practice Address - Phone:614-439-4650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.140731164W00000X
OH511378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse