Provider Demographics
NPI:1376801845
Name:WALKER, LISA J (LPN)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESEX
Mailing Address - State:NY
Mailing Address - Zip Code:14507-9606
Mailing Address - Country:US
Mailing Address - Phone:585-797-5005
Mailing Address - Fax:
Practice Address - Street 1:1826 WEST AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NY
Practice Address - Zip Code:14507-9606
Practice Address - Country:US
Practice Address - Phone:585-797-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183615164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse