Provider Demographics
NPI:1467155374
Name:VANDERWALKER, ALICIA (FPA-C)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:VANDERWALKER
Suffix:
Gender:F
Credentials:FPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 OLD NIAGARA RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1421
Mailing Address - Country:US
Mailing Address - Phone:716-343-0058
Mailing Address - Fax:
Practice Address - Street 1:6395 OLD NIAGARA RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-1421
Practice Address - Country:US
Practice Address - Phone:716-343-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist