Healthcare Provider Details

I. General information

NPI: 1942890587
Provider Name (Legal Business Name): NIQUEESHIA LADAWN HORTON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 STEELE AVE
DAYTON OH
45410-1606
US

IV. Provider business mailing address

610 STEELE AVE
DAYTON OH
45410-1606
US

V. Phone/Fax

Practice location:
  • Phone: 937-677-4393
  • Fax:
Mailing address:
  • Phone: 937-677-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberLPN-173621
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: