Provider Demographics
NPI:1639768773
Name:DOTSON, NICOLE (LVN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DOTSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14300 CORNERSTONE VILLAGE DR STE 226
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77014-1248
Mailing Address - Country:US
Mailing Address - Phone:832-302-0362
Mailing Address - Fax:281-624-4597
Practice Address - Street 1:14300 CORNERSTONE VILLAGE DR STE 226
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-1248
Practice Address - Country:US
Practice Address - Phone:832-302-0362
Practice Address - Fax:281-624-4597
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5245760164W00000X
TX348842164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX348842OtherTX BOARD OF NURSING