Provider Demographics
NPI:1033790100
Name:WALKER, LARA LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4745
Mailing Address - Country:US
Mailing Address - Phone:440-796-1204
Mailing Address - Fax:
Practice Address - Street 1:7230 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4745
Practice Address - Country:US
Practice Address - Phone:440-796-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN449141251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05071970OtherBIRTHDATE