Basic Information
| Provider Information | |||||||||
| NPI: | 1437106663 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHARDSON | ||||||||
| FirstName: | BRENT | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033012588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032249661 | ||||||||
| FaxNumber: | 6032287051 | ||||||||
| Practice Location | |||||||||
| Address1: | 246 PLEASANT STREET MEMORIAL BUILDING, WEST, GROUND FLO | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033012588 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032249661 | ||||||||
| FaxNumber: | 6032287051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 048496-23-03 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.