Healthcare Provider Details

I. General information

NPI: 1376801845
Provider Name (Legal Business Name): LISA J WALKER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 WEST AVE
MIDDLESEX NY
14507-9606
US

IV. Provider business mailing address

1826 WEST AVE
MIDDLESEX NY
14507-9606
US

V. Phone/Fax

Practice location:
  • Phone: 585-797-5005
  • Fax:
Mailing address:
  • Phone: 585-797-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number183615
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: