Provider Demographics
NPI:1093477861
Name:RICHARDSON TWITTY, VANESSA (HOMEMAKER)
Entity Type:Individual
Prefix:MISS
First Name:VANESSA
Middle Name:
Last Name:RICHARDSON TWITTY
Suffix:
Gender:F
Credentials:HOMEMAKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5208 SWEETLEAF DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4924
Mailing Address - Country:US
Mailing Address - Phone:937-305-1780
Mailing Address - Fax:
Practice Address - Street 1:5208 SWEETLEAF DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-4924
Practice Address - Country:US
Practice Address - Phone:937-305-1780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
OH0443191744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No376J00000XNursing Service Related ProvidersHomemaker