Provider Demographics
NPI:1447269428
Name:RICHARDSON, DERENDA JOELLE (ND)
Entity type:Individual
Prefix:DR
First Name:DERENDA
Middle Name:JOELLE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:MISS
Other - First Name:DERENDA
Other - Middle Name:DARLENE
Other - Last Name:WIEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED NCC
Mailing Address - Street 1:2025 HUDSON ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632
Mailing Address - Country:US
Mailing Address - Phone:360-261-2732
Mailing Address - Fax:360-442-4569
Practice Address - Street 1:2025 HUDSON ST
Practice Address - Street 2:UNIT 4
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632
Practice Address - Country:US
Practice Address - Phone:360-261-2732
Practice Address - Fax:360-442-4569
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00001372175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath