Provider Demographics
NPI:1942890587
Name:HORTON, NIQUEESHIA LADAWN (LPN)
Entity Type:Individual
Prefix:
First Name:NIQUEESHIA
Middle Name:LADAWN
Last Name:HORTON
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 1:610 STEELE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1606
Mailing Address - Country:US
Mailing Address - Phone:937-677-4393
Mailing Address - Fax:
Practice Address - Street 1:610 STEELE AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-1606
Practice Address - Country:US
Practice Address - Phone:937-677-4393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN-173621164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse