Provider Demographics
NPI:1487276507
Name:RICHARDSON, MARIE LOUISE (DNP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 HOURGLASS PL
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8025
Mailing Address - Country:US
Mailing Address - Phone:303-908-3975
Mailing Address - Fax:
Practice Address - Street 1:3101 HOURGLASS PL
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-8025
Practice Address - Country:US
Practice Address - Phone:303-908-3975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0994839-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily