Provider Demographics
NPI:1487004289
Name:HOUSE, LENEL
Entity Type:Individual
Prefix:
First Name:LENEL
Middle Name:
Last Name:HOUSE
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 1:1670 ROBERT ST S
Mailing Address - Street 2:UNIT267
Mailing Address - City:WEST ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3918
Mailing Address - Country:US
Mailing Address - Phone:612-270-2668
Mailing Address - Fax:
Practice Address - Street 1:1670 ROBERT ST S
Practice Address - Street 2:UNIT267
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3918
Practice Address - Country:US
Practice Address - Phone:612-270-2668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)