Provider Demographics
NPI:1689483661
Name:RICHARDSON-PARR, LONNIE CHARLES
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:CHARLES
Last Name:RICHARDSON-PARR
Suffix:
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 1:407 GIBBS AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-1531
Mailing Address - Country:US
Mailing Address - Phone:330-224-2243
Mailing Address - Fax:
Practice Address - Street 1:407 GIBBS AVE NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-1531
Practice Address - Country:US
Practice Address - Phone:330-224-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty