Provider Demographics
NPI:1932400587
Name:WALLS, TOYA LASHUN (LPN)
Entity Type:Individual
Prefix:
First Name:TOYA
Middle Name:LASHUN
Last Name:WALLS
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 1:12226 W BLUEMOUND RD APT 2
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3866
Mailing Address - Country:US
Mailing Address - Phone:414-491-6587
Mailing Address - Fax:
Practice Address - Street 1:12226 W BLUEMOUND RD APT 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3866
Practice Address - Country:US
Practice Address - Phone:414-491-6587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-14
Last Update Date:2010-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307264031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse