Provider Demographics
NPI:1982445110
Name:RICHARDSON, LETITIA C
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:C
Last Name:RICHARDSON
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 1:3290 WARRENSVILLE CENTER RD APT 302
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-3733
Mailing Address - Country:US
Mailing Address - Phone:216-799-1623
Mailing Address - Fax:
Practice Address - Street 1:3290 WARRENSVILLE CENTER RD APT 302
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-3733
Practice Address - Country:US
Practice Address - Phone:216-799-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide