Provider Demographics
NPI:1740058874
Name:RICHARDSON, CHESTER JOSIAH (APRN)
Entity type:Individual
Prefix:
First Name:CHESTER
Middle Name:JOSIAH
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3510
Mailing Address - Country:US
Mailing Address - Phone:207-249-9747
Mailing Address - Fax:
Practice Address - Street 1:193 MAIN ST STE 14
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5647
Practice Address - Country:US
Practice Address - Phone:207-294-7096
Practice Address - Fax:207-393-3470
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP231412363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health