Provider Demographics
NPI:1881763746
Name:RICHBURG, VIVIAN YVETTE (CRNA)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:YVETTE
Last Name:RICHBURG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 CHARTER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3258
Mailing Address - Country:US
Mailing Address - Phone:410-772-7345
Mailing Address - Fax:410-772-8860
Practice Address - Street 1:10710 CHARTER DR STE 120
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3258
Practice Address - Country:US
Practice Address - Phone:410-772-7345
Practice Address - Fax:410-772-8860
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175638367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered