Provider Demographics
NPI:1174702773
Name:SU-RICHARDSON, NGHI Q (CRNA)
Entity type:Individual
Prefix:
First Name:NGHI
Middle Name:Q
Last Name:SU-RICHARDSON
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 1:1245 S. CEDAR CREST BLVD., #301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-402-9099
Mailing Address - Fax:610-402-9029
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-9099
Practice Address - Fax:610-402-9029
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA079193367500000X
PARN500572L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50073177OtherCAPITAL ADVANTAGE
PA1997098OtherHIGHMARK
PA112048OtherGEISINGER
PA1997098OtherFIRST PRIORITY
PA1027795100001Medicaid
PA3126335000OtherIBC
PA9283471OtherAETNA
PA11879409OtherCAQH
PA1585277OtherGATEWAY
PA1027795100001Medicaid
PA1997098OtherFIRST PRIORITY