Provider Demographics
NPI:1164094686
Name:RICHARDSON, NEAL (LPN)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:MR
Other - First Name:NEAL
Other - Middle Name:
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:4926 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3122
Mailing Address - Country:US
Mailing Address - Phone:804-731-6423
Mailing Address - Fax:804-977-6244
Practice Address - Street 1:4926 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3122
Practice Address - Country:US
Practice Address - Phone:804-673-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002049705164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse