Provider Demographics
NPI:1144710898
Name:RICH, MESHALL D
Entity type:Individual
Prefix:MS
First Name:MESHALL
Middle Name:D
Last Name:RICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8069 BANVILLE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3401
Mailing Address - Country:US
Mailing Address - Phone:904-303-9258
Mailing Address - Fax:
Practice Address - Street 1:8069 BANVILLE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3401
Practice Address - Country:US
Practice Address - Phone:904-303-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion