Provider Demographics
NPI:1619286960
Name:WALKER, LISA MICHELLE (PAC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHELLE
Last Name:WALKER
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Gender:F
Credentials:PAC
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Mailing Address - Street 1:1425 RHONE VALLEY WAY
Mailing Address - Street 2:UNIT #77
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-5018
Mailing Address - Country:US
Mailing Address - Phone:619-934-3679
Mailing Address - Fax:619-934-3679
Practice Address - Street 1:NAVAL AIR STATION NORTH ISLAND
Practice Address - Street 2:BLDG 601 MCCAIN BLVD
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92135
Practice Address - Country:US
Practice Address - Phone:619-545-4263
Practice Address - Fax:619-545-0761
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
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Provider Licenses
StateLicense IDTaxonomies
FLPA9105302363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical