Provider Demographics
NPI:1629517396
Name:WALKER, LANISHA SHANAE'
Entity Type:Individual
Prefix:
First Name:LANISHA
Middle Name:SHANAE'
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21951 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2556
Mailing Address - Country:US
Mailing Address - Phone:248-506-7688
Mailing Address - Fax:
Practice Address - Street 1:21951 HARDING ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2556
Practice Address - Country:US
Practice Address - Phone:248-506-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other