Provider Demographics
NPI:1992901912
Name:RICHARDSON, GILDA C (HAIR REPLACEMENT SPE)
Entity type:Individual
Prefix:MRS
First Name:GILDA
Middle Name:C
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:HAIR REPLACEMENT SPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 VERBENA LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-8329
Mailing Address - Country:US
Mailing Address - Phone:513-236-0319
Mailing Address - Fax:513-755-0185
Practice Address - Street 1:740 NILLES RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3606
Practice Address - Country:US
Practice Address - Phone:513-236-0319
Practice Address - Fax:513-755-0185
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist