Diane Richardson Nurse Practitioner LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704110245 Issued in MI

Legal business name

DIANE RICHARDSON NURSE PRACTITIONER LLC

Practice address

0141 Port Sheldon Rd
Grandville, MI 49418

Phone

(616) 235-2090

Fax

(616) 235-2099

NPI assigned

Apr 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diane Richardson, NP

Title

Owner

Phone

(616) 235-2090

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415059200000",
    "number": "1487776332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1767",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495011767",
            "telephone_number": "616-235-2090",
            "fax_number": "616-235-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "0141 PORT SHELDON RD",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "49418",
            "telephone_number": "616-235-2090",
            "fax_number": "616-235-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANE RICHARDSON NURSE PRACTITIONER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2014-11-04",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-235-2090",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704110245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Grandville, MI
• Providers in Grandville, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.