Provider Demographics
NPI:1619127248
Name:WALTON, DISHANNA TOMEKA
Entity Type:Individual
Prefix:
First Name:DISHANNA
Middle Name:TOMEKA
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DISHANNA
Other - Middle Name:TOMEKA
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1770 IDLEHURST DR
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1848
Mailing Address - Country:US
Mailing Address - Phone:216-554-2234
Mailing Address - Fax:
Practice Address - Street 1:1770 IDLEHURST DR
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1848
Practice Address - Country:US
Practice Address - Phone:216-554-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117858164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse