Provider Demographics
NPI:1619366903
Name:RICHARDS, JENEVIEVE (LPN)
Entity Type:Individual
Prefix:
First Name:JENEVIEVE
Middle Name:
Last Name:RICHARDS
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 1:35 SILVER LAKE SCOTCHTOWN RD
Mailing Address - Street 2:BUILDING 3 APT 5A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2817
Mailing Address - Country:US
Mailing Address - Phone:727-412-0432
Mailing Address - Fax:
Practice Address - Street 1:777 WESTCHESTER AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3520
Practice Address - Country:US
Practice Address - Phone:727-412-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31888-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse