Provider Demographics
NPI:1447900220
Name:RICHARDS, MICHELLE LORRAINE (RN, CMGT-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LORRAINE
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:RN, CMGT-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LORRAINE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CMGT-BC
Mailing Address - Street 1:472 POLARIS ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23461-1935
Mailing Address - Country:US
Mailing Address - Phone:757-981-1535
Mailing Address - Fax:
Practice Address - Street 1:472 POLARIS ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23461-1935
Practice Address - Country:US
Practice Address - Phone:757-981-1535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001231601163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management