Provider Demographics
NPI:1194472803
Name:TROTTER, DONIQUE KENDRA (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:DONIQUE
Middle Name:KENDRA
Last Name:TROTTER
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:DONIQUE
Other - Middle Name:
Other - Last Name:COLBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN IBCLC
Mailing Address - Street 1:1621 LAKEVILLE DR STE 304
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2694
Mailing Address - Country:US
Mailing Address - Phone:281-305-0411
Mailing Address - Fax:281-572-0627
Practice Address - Street 1:633 E FERNHURST DR STE 204
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1586
Practice Address - Country:US
Practice Address - Phone:281-305-0411
Practice Address - Fax:281-572-0627
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX724720163W00000X
VA130084163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse