Provider Demographics
NPI:1407128697
Name:WALKER, AUTUMN YVONNE (LPN)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:YVONNE
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 1:200 FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-3764
Mailing Address - Country:US
Mailing Address - Phone:269-753-9151
Mailing Address - Fax:
Practice Address - Street 1:200 FREMONT ST
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3764
Practice Address - Country:US
Practice Address - Phone:269-753-9151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703100328164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse