Healthcare Provider Details

I. General information

NPI: 1447496781
Provider Name (Legal Business Name): LAURIE NIX DYKOSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 FOUNTAIN VIEW DR SUITE 200
HOUSTON TX
77057-4817
US

IV. Provider business mailing address

2411 FOUNTAIN VIEW DR SUITE 200
HOUSTON TX
77057-4817
US

V. Phone/Fax

Practice location:
  • Phone: 713-620-4000
  • Fax: 713-620-4098
Mailing address:
  • Phone: 713-620-4000
  • Fax: 713-620-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberN3017
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: