Provider Demographics
NPI:1982824629
Name:RICHARDSON, DONNA LYNNE (APRN-BC)
Entity Type:Individual
Prefix:MR
First Name:DONNA
Middle Name:LYNNE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GILLETTE PARK
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1028
Mailing Address - Country:US
Mailing Address - Phone:617-463-3499
Mailing Address - Fax:617-463-4122
Practice Address - Street 1:1 GILLETTE PARK
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1028
Practice Address - Country:US
Practice Address - Phone:617-463-3499
Practice Address - Fax:617-463-4122
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA102239363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARI NP2398Medicare ID - Type UnspecifiedNURSE PRACTITIONER
MAPO5337Medicare UPIN