Provider Demographics
NPI:1811270499
Name:WALKER, LISA S
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:S
Last Name:WALKER
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 1:392 MCNAUGHTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2646
Mailing Address - Country:US
Mailing Address - Phone:585-766-8249
Mailing Address - Fax:585-254-2133
Practice Address - Street 1:392 MCNAUGHTON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2646
Practice Address - Country:US
Practice Address - Phone:585-766-8249
Practice Address - Fax:585-254-2133
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY303723164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse