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General NPI Number Information
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NPI Number | 1174890891
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Entity Type | Individual
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Provider Name | BRETT LYNN RICHARDS LPN
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Gender | Male
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Dates
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Enumeration Date | 11/23/2011
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Last Update Date | 11/23/2011
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Provider Practice Location Address
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Address Line | 79 BIRCH PARK DR
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City | NEW LONDON
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State | OH
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Zip | 44851-1103
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Country | US
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Telephone | 419-202-9483
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Fax |
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Provider Business Mailing Address
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Address Line | 79 BIRCH PARK DR
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City | NEW LONDON
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State | OH
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Zip | 44851-1103
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Country | US
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Telephone | 419-202-9483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN.136100-M-IV
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License Number State | OH
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