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General NPI Number Information
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NPI Number | 1689201337
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Entity Type | Individual
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Provider Name | LISA KEBALO-WALKER APN
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 151 KNOLLCROFT RD
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City | LYONS
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State | NJ
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Zip | 07939-5001
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Country | US
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Telephone | 732-259-6671
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Fax |
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Provider Business Mailing Address
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Address Line | 151 KNOLLCROFT RD
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City | LYONS
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State | NJ
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Zip | 07939-5001
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Country | US
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Telephone | 732-259-6671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | 26NJ01018400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 26NJ01018400
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 163WC2100X
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Taxonomy Name | Continence Care Registered Nurse
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License Number | 26NR11264700
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 26NR11264700
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License Number State | NJ
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Taxonomy #5
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Taxonomy Code | 163WX1500X
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Taxonomy Name | Ostomy Care Registered Nurse
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License Number | 26NR11264700
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License Number State | NJ
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