Healthcare Provider Details

I. General information

NPI: 1063722205
Provider Name (Legal Business Name): VICKIE DARLENE WALKER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 LENWOOD DR
LANCASTER OH
43130-2211
US

IV. Provider business mailing address

212 LENWOOD DRIVE
LANCASTER OH
43130
US

V. Phone/Fax

Practice location:
  • Phone: 304-481-6124
  • Fax:
Mailing address:
  • Phone: 304-481-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number099249
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number099249
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number099249
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number099249
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number099249
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: