Provider Demographics
NPI:1013057215
Name:RICHARDS, JOHN MICHAEL (NP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3849
Mailing Address - Country:US
Mailing Address - Phone:503-266-7686
Mailing Address - Fax:503-266-7382
Practice Address - Street 1:703 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3849
Practice Address - Country:US
Practice Address - Phone:503-266-7686
Practice Address - Fax:503-266-7382
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000038332N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR017033Medicaid
OR017033Medicaid
ORS47545Medicare UPIN