Provider Demographics
NPI:1104472331
Name:HOUSTON, ELLA (REGISTERED NURSE)
Entity type:Individual
Prefix:MISS
First Name:ELLA
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LINCOLN HWY STE 222
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3965
Mailing Address - Country:US
Mailing Address - Phone:845-612-1228
Mailing Address - Fax:
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-454-8500
Practice Address - Fax:845-483-6122
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY450075163W00000X
NY450075-1163W00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministratorGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty