Provider Demographics
NPI:1043540255
Name:RICHARDSON, PEPPER L (LPN)
Entity type:Individual
Prefix:MRS
First Name:PEPPER
Middle Name:L
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 OCONNOR RD
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5861
Mailing Address - Country:US
Mailing Address - Phone:315-640-0774
Mailing Address - Fax:
Practice Address - Street 1:661 OCONNOR RD
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-5861
Practice Address - Country:US
Practice Address - Phone:315-640-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278191-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse