Provider Demographics
NPI:1497172266
Name:WALKER, SHANEIKA L (LPN)
Entity Type:Individual
Prefix:MISS
First Name:SHANEIKA
Middle Name:L
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 1:18650 GRIGGS ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1908
Mailing Address - Country:US
Mailing Address - Phone:313-912-5606
Mailing Address - Fax:
Practice Address - Street 1:18650 GRIGGS ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1908
Practice Address - Country:US
Practice Address - Phone:313-912-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703109868164W00000X
MI4704336139163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse