Provider Demographics
NPI:1609327485
Name:RICHARDS, LAILA DYAN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAILA
Middle Name:DYAN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:CADIZ
Mailing Address - State:OH
Mailing Address - Zip Code:43907-1153
Mailing Address - Country:US
Mailing Address - Phone:740-632-5129
Mailing Address - Fax:
Practice Address - Street 1:15655 STATE ROUTE 170 STE B
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9672
Practice Address - Country:US
Practice Address - Phone:330-932-0909
Practice Address - Fax:330-932-0769
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN53777NP363LF0000X
OHAPRN.CNP.020293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0223673Medicaid