Provider Demographics
NPI:1962622191
Name:RICHMOND, PAMELA GAIL
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:GAIL
Last Name:RICHMOND
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 1:6371 SILVER LEAF AVE
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1023
Mailing Address - Country:US
Mailing Address - Phone:614-861-5159
Mailing Address - Fax:
Practice Address - Street 1:293 RED JADE PLACE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1023
Practice Address - Country:US
Practice Address - Phone:614-575-8252
Practice Address - Fax:614-575-8252
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2586974Medicaid
OH2535199OtherMMRD
0747Medicare UPIN