Healthcare Provider Details

I. General information

NPI: 1457265563
Provider Name (Legal Business Name): MRS. LAVITA JONELLLE WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10979 MOUNTAIN ASH AVE NW
GRAND RAPIDS MI
49534-6710
US

IV. Provider business mailing address

10979 MOUNTAIN ASH AVE NW
GRAND RAPIDS MI
49534-6710
US

V. Phone/Fax

Practice location:
  • Phone: 616-401-0492
  • Fax:
Mailing address:
  • Phone: 616-401-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: