Healthcare Provider Details

I. General information

NPI: 1518596543
Provider Name (Legal Business Name): LETITIA A DEBRILL-RICHARDSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 5254
DAYTON OH
45409-2939
US

IV. Provider business mailing address

6736 GALAXIE DR
DAYTON OH
45415-1438
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4200
  • Fax: 937-208-2678
Mailing address:
  • Phone: 937-422-9128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number377007
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number377007
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number377007
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number377007
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN.CNP.0033356
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0033356
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0033356
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.0033356
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: