Provider Demographics
NPI:1700070539
Name:WALKER, LAKISHA NICOLE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:NICOLE
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 1:10017 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-6306
Mailing Address - Country:US
Mailing Address - Phone:216-812-5251
Mailing Address - Fax:
Practice Address - Street 1:10017 PARKVIEW AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-6306
Practice Address - Country:US
Practice Address - Phone:216-812-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN109639164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2705433Medicaid