Provider Demographics
NPI:1356054159
Name:RICHARDSON, HEATHER R (RN,NRP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:RN,NRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 N SHEA ESTS
Mailing Address - Street 2:
Mailing Address - City:SOLSBERRY
Mailing Address - State:IN
Mailing Address - Zip Code:47459-6063
Mailing Address - Country:US
Mailing Address - Phone:812-826-6000
Mailing Address - Fax:
Practice Address - Street 1:1536 N SHEA ESTS
Practice Address - Street 2:
Practice Address - City:SOLSBERRY
Practice Address - State:IN
Practice Address - Zip Code:47459-6063
Practice Address - Country:US
Practice Address - Phone:812-826-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INM5001477146L00000X
IN28248451A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic