Provider Demographics
NPI:1952799066
Name:RICHARDS, CRISTILLY (LPN)
Entity Type:Individual
Prefix:
First Name:CRISTILLY
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 1:9100 E FLORIDA AVE
Mailing Address - Street 2:APT 21-204
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-2845
Mailing Address - Country:US
Mailing Address - Phone:301-275-5419
Mailing Address - Fax:
Practice Address - Street 1:656 DILLON WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6803
Practice Address - Country:US
Practice Address - Phone:303-344-0636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-26
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLP50301164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse