Provider Demographics
NPI:1487478913
Name:LINE, DASHEA NIKKOLE (RN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:DASHEA
Middle Name:NIKKOLE
Last Name:LINE
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 YELLOW WARBLER RUN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-2319
Mailing Address - Country:US
Mailing Address - Phone:806-367-0520
Mailing Address - Fax:
Practice Address - Street 1:1231 YELLOW WARBLER RUN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-2319
Practice Address - Country:US
Practice Address - Phone:806-367-0520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX780770163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty