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NPI Code Detail

MEDICARE: DOMINIQUE WALTON LPN

MEDICARE: DOMINIQUE WALTON LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLPN.165940OH

General Provider Information

NPI Number : 1568922177
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOMINIQUE WALTON LPN
Provider Business Mailing Address
First Line : 3548 FENLEY RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44121-1346
Country : US
Telephone Number : 216-501-8997
Fax Number :
Provider Business Practice Location Address
First Line : 402 GOLFVIEW LN
Second Line :
City : HIGHLAND HEIGHTS
State : OH
Zip : 44143-4414
Country : US
Telephone Number : 440-443-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2019
Last Update Date : 03/20/2019

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