Provider Demographics
NPI:1225437767
Name:WALKER, NICOLE ANNE (LPMC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 SALT SPRINGS RD
Mailing Address - Street 2:COTTAGE 6, 3RD FLR
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1639
Mailing Address - Country:US
Mailing Address - Phone:315-446-6250
Mailing Address - Fax:
Practice Address - Street 1:960 SALT SPRINGS RD
Practice Address - Street 2:COTTAGE 6, 3RD FLR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1639
Practice Address - Country:US
Practice Address - Phone:315-446-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health