Provider Demographics
NPI:1316204845
Name:RICHARDSON, JILL MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 GRANGE HALL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-3711
Mailing Address - Country:US
Mailing Address - Phone:937-207-4928
Mailing Address - Fax:
Practice Address - Street 1:4041 GRANGE HALL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-3711
Practice Address - Country:US
Practice Address - Phone:937-207-4928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.121364164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse