Provider Demographics
NPI:1922359330
Name:WALTON, KRISTINE ELAINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:ELAINE
Last Name:WALTON
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 1:1865 E 39TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-2601
Mailing Address - Country:US
Mailing Address - Phone:440-213-3627
Mailing Address - Fax:
Practice Address - Street 1:1865 E 39TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-2601
Practice Address - Country:US
Practice Address - Phone:440-213-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN128504IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse