Provider Demographics
NPI:1215559729
Name:RICHARDSON, TRESHANNA (LVN)
Entity Type:Individual
Prefix:
First Name:TRESHANNA
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6733 MONTGOMERY APT 403
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-3287
Mailing Address - Country:US
Mailing Address - Phone:210-386-7984
Mailing Address - Fax:
Practice Address - Street 1:6733 MONTGOMERY APT 403
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78239-3287
Practice Address - Country:US
Practice Address - Phone:210-386-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233899164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse