Provider Demographics
NPI:1649414053
Name:HOUSE, VONETTA (LPN)
Entity Type:Individual
Prefix:
First Name:VONETTA
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 STONE RD
Mailing Address - Street 2:APT. 5
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1522
Mailing Address - Country:US
Mailing Address - Phone:585-244-5150
Mailing Address - Fax:
Practice Address - Street 1:1694 STONE RD
Practice Address - Street 2:APT. 5
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-1522
Practice Address - Country:US
Practice Address - Phone:585-244-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284387-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse