Provider Demographics
NPI:1205446861
Name:WASHINGTON, MAKEBA JANEA (LPN)
Entity type:Individual
Prefix:
First Name:MAKEBA
Middle Name:JANEA
Last Name:WASHINGTON
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 1:1623 HORIZON ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-4048
Mailing Address - Country:US
Mailing Address - Phone:469-682-9506
Mailing Address - Fax:
Practice Address - Street 1:1623 HORIZON ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-4048
Practice Address - Country:US
Practice Address - Phone:469-682-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374J00000X
TX310302164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374J00000XNursing Service Related ProvidersDoula