Provider Demographics
NPI:1710366935
Name:WALKER, KATINA (LPN)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:
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 1:9221 TOWERING PINE DRIVE
Mailing Address - Street 2:F
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-5828
Mailing Address - Country:US
Mailing Address - Phone:937-241-5189
Mailing Address - Fax:
Practice Address - Street 1:9221 TOWERING PINE DRIVE
Practice Address - Street 2:F
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-5828
Practice Address - Country:US
Practice Address - Phone:937-241-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.134171-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse