Provider Demographics
NPI:1114494473
Name:LAIRD, JUSTIN (LVN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:
Last Name:LAIRD
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21455 PLEASANT FOREST BND
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4779
Mailing Address - Country:US
Mailing Address - Phone:832-542-9187
Mailing Address - Fax:
Practice Address - Street 1:21455 PLEASANT FOREST BND
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4779
Practice Address - Country:US
Practice Address - Phone:832-542-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX344939164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse