Provider Demographics
NPI:1669845087
Name:RICHMOND, JASON (RN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-1508
Mailing Address - Country:US
Mailing Address - Phone:570-963-1278
Mailing Address - Fax:570-963-1292
Practice Address - Street 1:2013 BOULEVARD AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-1205
Practice Address - Country:US
Practice Address - Phone:570-963-1276
Practice Address - Fax:570-558-2455
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN634070163W00000X, 163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163W00000XNursing Service ProvidersRegistered Nurse