Provider Demographics
NPI:1275091969
Name:WALKER, ALICIA I (RN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WALKER
Suffix:I
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:ALICIA
Other - Middle Name:M
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:500 FAIRGROUND RD
Mailing Address - Street 2:
Mailing Address - City:WEST WINFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:13491-2006
Mailing Address - Country:US
Mailing Address - Phone:315-822-2928
Mailing Address - Fax:315-822-3486
Practice Address - Street 1:500 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:WEST WINFIELD
Practice Address - State:NY
Practice Address - Zip Code:13491-2006
Practice Address - Country:US
Practice Address - Phone:315-822-2928
Practice Address - Fax:315-822-3486
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641553-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0000Medicaid