Provider Demographics
NPI:1467289850
Name:HOUSTON, LANDRA
Entity type:Individual
Prefix:
First Name:LANDRA
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18691 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:GAMBIER
Mailing Address - State:OH
Mailing Address - Zip Code:43022-9709
Mailing Address - Country:US
Mailing Address - Phone:740-398-4340
Mailing Address - Fax:
Practice Address - Street 1:18691 GLEN RD
Practice Address - Street 2:
Practice Address - City:GAMBIER
Practice Address - State:OH
Practice Address - Zip Code:43022-9709
Practice Address - Country:US
Practice Address - Phone:740-398-4340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker