Provider Demographics
NPI:1326213182
Name:WALKER, LYNNE MICHELE
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MICHELE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2533 CARTER GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-3417
Mailing Address - Country:US
Mailing Address - Phone:407-876-4801
Mailing Address - Fax:407-876-0054
Practice Address - Street 1:2533 CARTER GROVE CIR
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-3417
Practice Address - Country:US
Practice Address - Phone:407-876-4801
Practice Address - Fax:407-876-0054
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL300162800Medicaid