Provider Demographics
NPI:1023465994
Name:RICHARDSON, DOMINIQUE M (CLD)
Entity type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 KOSSUTH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-3230
Mailing Address - Country:US
Mailing Address - Phone:609-284-2562
Mailing Address - Fax:
Practice Address - Street 1:236 KOSSUTH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:NJ
Practice Address - Zip Code:08075-3230
Practice Address - Country:US
Practice Address - Phone:609-284-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula