Provider Demographics
NPI:1053294413
Name:RICHARDS, MENETTA D
Entity type:Individual
Prefix:
First Name:MENETTA
Middle Name:D
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 30TH AVE S APT 430
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2985
Mailing Address - Country:US
Mailing Address - Phone:609-532-5228
Mailing Address - Fax:
Practice Address - Street 1:900 30TH AVE S APT 430
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2985
Practice Address - Country:US
Practice Address - Phone:609-532-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker