Provider Demographics
NPI:1467082859
Name:HORTON, WAYNE THOMAS
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:THOMAS
Last Name:HORTON
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 1:319 VIRGINIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3449
Mailing Address - Country:US
Mailing Address - Phone:202-250-4936
Mailing Address - Fax:
Practice Address - Street 1:2301 11TH ST NW APT 313
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2256
Practice Address - Country:US
Practice Address - Phone:540-970-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty