Provider Demographics
NPI:1679587117
Name:RICHARDS, BRUCE AIKEN (LPN)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:AIKEN
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E OAK ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3826
Mailing Address - Country:US
Mailing Address - Phone:330-678-2926
Mailing Address - Fax:
Practice Address - Street 1:122 E OAK ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3826
Practice Address - Country:US
Practice Address - Phone:330-678-2926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN087483IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2578634Medicaid