Provider Demographics
NPI:1134546088
Name:RICHMOND, MICHAEL TROY (LPN)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TROY
Last Name:RICHMOND
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 1:8 PATRICIA LN
Mailing Address - Street 2:
Mailing Address - City:BERNHARDS BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13028-4158
Mailing Address - Country:US
Mailing Address - Phone:315-751-4685
Mailing Address - Fax:
Practice Address - Street 1:8 PATRICIA LN
Practice Address - Street 2:
Practice Address - City:BERNHARDS BAY
Practice Address - State:NY
Practice Address - Zip Code:13028-4158
Practice Address - Country:US
Practice Address - Phone:315-751-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse