Provider Demographics
NPI:1700075488
Name:WALKER, ALERICE E (PA)
Entity Type:Individual
Prefix:MS
First Name:ALERICE
Middle Name:E
Last Name:WALKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALERICE
Other - Middle Name:E
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2743
Mailing Address - Country:US
Mailing Address - Phone:203-426-0494
Mailing Address - Fax:
Practice Address - Street 1:2101 ROSECRANS AVE # 3230
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4749
Practice Address - Country:US
Practice Address - Phone:323-628-8671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008642363A00000X
CT001804363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant