Provider Demographics
NPI:1144624578
Name:RICHARDSON, LANIECE
Entity type:Individual
Prefix:
First Name:LANIECE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LANIECE
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:27400 CHARDON RD
Mailing Address - Street 2:APT 913
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44092-2901
Mailing Address - Country:US
Mailing Address - Phone:216-413-7200
Mailing Address - Fax:
Practice Address - Street 1:27400 CHARDON RD
Practice Address - Street 2:APT 913
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44092-2901
Practice Address - Country:US
Practice Address - Phone:440-796-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH416319163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse