Provider Demographics
NPI:1952187148
Name:RICHMOND, MORGAN (RD, CEDS-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:RD, CEDS-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 S 19TH PL
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1054 S 19TH PL
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-1091
Practice Address - Country:US
Practice Address - Phone:920-527-1158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD006029133V00000X
TN4115133V00000X
PADN007713133V00000X
MN4424133V00000X
IL164007480133V00000X
FLND9089133V00000X
WADI61208236133V00000X
WI2815-29133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered