Provider Demographics
NPI:1174890891
Name:RICHARDS, BRETT LYNN (LPN)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:LYNN
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 1:79 BIRCH PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:44851-1103
Mailing Address - Country:US
Mailing Address - Phone:419-202-9483
Mailing Address - Fax:
Practice Address - Street 1:79 BIRCH PARK DR
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:OH
Practice Address - Zip Code:44851-1103
Practice Address - Country:US
Practice Address - Phone:419-202-9483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.136100-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse