Provider Demographics
NPI:1144484114
Name:RICHARDSON, LORI D (LPN)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8724 109TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2233
Mailing Address - Country:US
Mailing Address - Phone:347-233-3171
Mailing Address - Fax:
Practice Address - Street 1:8724 109TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2233
Practice Address - Country:US
Practice Address - Phone:347-233-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293575-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse