Healthcare Provider Details

I. General information

NPI: 1134558190
Provider Name (Legal Business Name): LISA A WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2013
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 S WOLFE ST APT 460
BALTIMORE MD
21231-3621
US

IV. Provider business mailing address

915 S WOLFE ST APT 460
BALTIMORE MD
21231-3621
US

V. Phone/Fax

Practice location:
  • Phone: 941-685-1014
  • Fax:
Mailing address:
  • Phone: 941-685-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: