| Doctor Name: | DIANE K RICHARDSON |
| NPI Number: | 1093781858 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 4704110245 |
| Business Practice Address: | 141 Port Sheldon Rd Sw Grandville, MI - 494182149 |
| Business Phone Number: | 6162352090 |
| Business Fax Number: | 6162352099 |
| Mailing Address: | Po Box 1767, GRAND RAPIDS |
| State: | MI |
| Postal Code: | 495011767 |
| Phone Number: | 6162352090 |
| Fax Number: | 6162352099 |
| NPI Enumeration Date: | 02/23/2006 |
| NPI Last Update Date: | 10/03/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0808X |
| License Number: | 4704110245 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |