MEDICARE: SHAVON RICHARDS LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	122503	OH

General Provider Information

NPI Number	:	1245439520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAVON RICHARDS LPN

Provider Business Mailing Address
First Line	:	5235 HERONCREEK BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-7626
Country	:	US
Telephone Number	:	216-401-5742
Fax Number	:

Provider Business Practice Location Address
First Line	:	5235 HERONCREEK BLVD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-7626
Country	:	US
Telephone Number	:	216-401-5742
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	04/10/2009

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