Provider Demographics
NPI:1194601567
Name:RICHARDSON, MELVIN I
Entity type:Individual
Prefix:MR
First Name:MELVIN
Middle Name:
Last Name:RICHARDSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7621 CHERRYWOOD DR APT 12
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-5306
Mailing Address - Country:US
Mailing Address - Phone:402-202-9118
Mailing Address - Fax:
Practice Address - Street 1:7621 CHERRYWOOD DR APT 12
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-5306
Practice Address - Country:US
Practice Address - Phone:402-202-9118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEG02074851374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty