Provider Demographics
NPI:1053403311
Name:PURDHAM, RICHARD SPENCER (RN, CRNA)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SPENCER
Last Name:PURDHAM
Suffix:
Gender:M
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:DICK
Other - Middle Name:
Other - Last Name:PURDHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:214 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-9413
Mailing Address - Country:US
Mailing Address - Phone:910-997-3800
Mailing Address - Fax:910-997-3800
Practice Address - Street 1:WOMACK ARMY MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse