Provider Demographics
NPI:1871762468
Name:RICHMOND, CONNIE MARIE (LVN)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:MARIE
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 MERCED ST
Mailing Address - Street 2:
Mailing Address - City:NEWMAN
Mailing Address - State:CA
Mailing Address - Zip Code:95360
Mailing Address - Country:US
Mailing Address - Phone:209-862-0270
Mailing Address - Fax:209-862-0274
Practice Address - Street 1:637 MERCED ST
Practice Address - Street 2:
Practice Address - City:NEWMAN
Practice Address - State:CA
Practice Address - Zip Code:95360
Practice Address - Country:US
Practice Address - Phone:209-862-0270
Practice Address - Fax:209-862-0274
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN104088164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse