Provider Demographics
NPI:1346995743
Name:WALKER, HEIDI (LPN, CLC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 FORMOSA DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2021
Mailing Address - Country:US
Mailing Address - Phone:910-934-1867
Mailing Address - Fax:
Practice Address - Street 1:113 FORMOSA DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2021
Practice Address - Country:US
Practice Address - Phone:910-934-1867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN257981L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse