Provider Demographics
NPI:1033704135
Name:RICHARD, ISABELLA ANNA (FNP)
Entity type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:ANNA
Last Name:RICHARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:ISABELLA
Other - Middle Name:ANNA
Other - Last Name:KOPKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:926 SOUTHBRIDGE ST APT 17
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01610-2254
Mailing Address - Country:US
Mailing Address - Phone:508-353-4611
Mailing Address - Fax:
Practice Address - Street 1:926 SOUTHBRIDGE ST APT 17
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01610-2254
Practice Address - Country:US
Practice Address - Phone:508-353-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2294712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine