Provider Demographics
NPI:1104517739
Name:HOUSTON, MICHELLE N (RN)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:N
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8236 E BRANCH DR
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-2025
Mailing Address - Country:US
Mailing Address - Phone:301-613-0346
Mailing Address - Fax:
Practice Address - Street 1:4901 TESLA DR STE A
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4407
Practice Address - Country:US
Practice Address - Phone:301-805-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162041163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)