Provider Demographics
NPI:1871046938
Name:RICHARDSON, LYNETTE (CNA)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4697 HARVEST KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4714
Mailing Address - Country:US
Mailing Address - Phone:901-612-6966
Mailing Address - Fax:901-730-1127
Practice Address - Street 1:4697 HARVEST KNOLL LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4714
Practice Address - Country:US
Practice Address - Phone:901-612-6966
Practice Address - Fax:901-730-1127
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00173063376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide