Provider Demographics
NPI:1851722151
Name:LHERISSON, DEJENA (LVN)
Entity Type:Individual
Prefix:MS
First Name:DEJENA
Middle Name:
Last Name:LHERISSON
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 1:3500 E PARK BLVD
Mailing Address - Street 2:901A
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3139
Mailing Address - Country:US
Mailing Address - Phone:469-404-8426
Mailing Address - Fax:972-423-6013
Practice Address - Street 1:3500 E PARK BLVD
Practice Address - Street 2:901A
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3139
Practice Address - Country:US
Practice Address - Phone:469-404-8426
Practice Address - Fax:972-423-6013
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308721164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse