Provider Demographics
NPI:1891471611
Name:RICHARDS, CAROL JEAN
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-0006
Mailing Address - Country:US
Mailing Address - Phone:330-348-3584
Mailing Address - Fax:
Practice Address - Street 1:242 W RIDDLE AVE
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2949
Practice Address - Country:US
Practice Address - Phone:330-348-3584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty