Provider Demographics
NPI:1548913569
Name:RICHMOND, PATINA RENEE (RN)
Entity type:Individual
Prefix:MRS
First Name:PATINA
Middle Name:RENEE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 BEXLEY DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3835
Mailing Address - Country:US
Mailing Address - Phone:330-675-9921
Mailing Address - Fax:
Practice Address - Street 1:1495 BEXLEY DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3835
Practice Address - Country:US
Practice Address - Phone:330-675-9921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA747071163W00000X
OH408460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse