Provider Demographics
NPI:1922678176
Name:HOUSTON, LILLIAN LEORA (LPN)
Entity Type:Individual
Prefix:
First Name:LILLIAN
Middle Name:LEORA
Last Name:HOUSTON
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 1:218 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1781
Mailing Address - Country:US
Mailing Address - Phone:440-231-1375
Mailing Address - Fax:
Practice Address - Street 1:218 SUNSET RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1781
Practice Address - Country:US
Practice Address - Phone:440-231-1375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.178723MEDIV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse