Provider Demographics
NPI:1831832617
Name:RICHARDS,, LISA SUE (BS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SUE
Last Name:RICHARDS,
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E MESCALERO RD
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6542
Mailing Address - Country:US
Mailing Address - Phone:575-755-2272
Mailing Address - Fax:575-622-3325
Practice Address - Street 1:1010 S GARDEN AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-6866
Practice Address - Country:US
Practice Address - Phone:575-623-7660
Practice Address - Fax:575-627-0405
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator