Provider Demographics
NPI:1154693489
Name:HORTON, HENRY LLOYD (LPN)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:LLOYD
Last Name:HORTON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8398A SHALLOWCREEK RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1318
Mailing Address - Country:US
Mailing Address - Phone:315-516-1463
Mailing Address - Fax:
Practice Address - Street 1:8398A SHALLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1318
Practice Address - Country:US
Practice Address - Phone:315-516-1463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302812164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse