Provider Demographics
NPI:1619217361
Name:RICHWINE, MICHELLE (CRNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RICHWINE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5802
Mailing Address - Country:US
Mailing Address - Phone:410-768-8525
Mailing Address - Fax:
Practice Address - Street 1:202 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5802
Practice Address - Country:US
Practice Address - Phone:410-768-8525
Practice Address - Fax:410-768-9757
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR157942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1209422OtherAMERICHOICE
MD65039006OtherCAREFIRST
MD925009300OtherMEDICAL ASSISTANCE