Provider Demographics
NPI:1699367300
Name:WALTON, CIERRA NICOLE
Entity Type:Individual
Prefix:
First Name:CIERRA
Middle Name:NICOLE
Last Name:WALTON
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 1:154 LINCOLN AVE APT 115
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3807
Mailing Address - Country:US
Mailing Address - Phone:707-816-0348
Mailing Address - Fax:
Practice Address - Street 1:154 LINCOLN AVE APT 115
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3807
Practice Address - Country:US
Practice Address - Phone:707-816-0348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist