Provider Demographics
NPI:1871763276
Name:RICHMOND, DEBORAH ANNE (CNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:248-581-5972
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:3901 CHRYSLER DR
Practice Address - Street 2:STE 4A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2167
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-577-3777
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704125568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P32180037Medicare PIN