Provider Demographics
NPI:1548655038
Name:RICHARD, TANIA (CNM/WHNP)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:RICHARD
Suffix:
Gender:F
Credentials:CNM/WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EASTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6010
Mailing Address - Country:US
Mailing Address - Phone:860-912-2133
Mailing Address - Fax:
Practice Address - Street 1:17 EASTWOOD RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6010
Practice Address - Country:US
Practice Address - Phone:860-912-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006376363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology