Provider Demographics
NPI:1720358468
Name:HOUSTON, ESTEE LAUDER (STNA)
Entity Type:Individual
Prefix:MISS
First Name:ESTEE
Middle Name:LAUDER
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43620-1040
Mailing Address - Country:US
Mailing Address - Phone:419-699-2816
Mailing Address - Fax:
Practice Address - Street 1:2438 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43620-1040
Practice Address - Country:US
Practice Address - Phone:419-699-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401331441211376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide