Healthcare Provider Details

I. General information

NPI: 1902479835
Provider Name (Legal Business Name): LAODECIA WALKER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28264 SPRING CREEK WAY
MENIFEE CA
92585-9382
US

IV. Provider business mailing address

28264 SPRING CREEK WAY
MENIFEE CA
92585-9382
US

V. Phone/Fax

Practice location:
  • Phone: 951-415-1115
  • Fax:
Mailing address:
  • Phone: 951-575-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number378812
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: