Provider Demographics
NPI:1447079843
Name:RICHARDS, MICKAYLIA
Entity type:Individual
Prefix:
First Name:MICKAYLIA
Middle Name:
Last Name:RICHARDS
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 1:1200 ELM ST UNIT 314
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2519
Mailing Address - Country:US
Mailing Address - Phone:603-892-2828
Mailing Address - Fax:
Practice Address - Street 1:1200 ELM ST UNIT 314
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2519
Practice Address - Country:US
Practice Address - Phone:603-892-2828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHI0390374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1447079843OtherLEILA CARE SOLUTIONS LLC