Provider Demographics
NPI:1144942624
Name:RICHARDSON, SARENA (FNP-C)
Entity type:Individual
Prefix:
First Name:SARENA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 N MOZART ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1579
Mailing Address - Country:US
Mailing Address - Phone:847-224-0751
Mailing Address - Fax:
Practice Address - Street 1:153 1/2 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3702
Practice Address - Country:US
Practice Address - Phone:708-345-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA235130363LP2300X
IL209025950363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care