Provider Demographics
NPI:1669916623
Name:RICHARDSON, LOURDES (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22953 TOSCANA DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-9056
Mailing Address - Country:US
Mailing Address - Phone:708-351-9599
Mailing Address - Fax:
Practice Address - Street 1:6360 159TH ST STE A-B
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-2725
Practice Address - Country:US
Practice Address - Phone:708-687-4620
Practice Address - Fax:708-687-4625
Is Sole Proprietor?:No
Enumeration Date:2016-12-10
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041273555163W00000X
IL209015247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse