Provider Demographics
NPI:1184066102
Name:HOUSTON, DIONDRA RESCHELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:DIONDRA
Middle Name:RESCHELLE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:DIONDRA
Other - Middle Name:RESCHELLE
Other - Last Name:FOWLKES; SPEIGHT; BOLES; FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1252
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-0252
Mailing Address - Country:US
Mailing Address - Phone:910-988-0555
Mailing Address - Fax:
Practice Address - Street 1:1670 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4004
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60261164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse