Provider Demographics
NPI:1932433166
Name:WALKER, DALISA RANELLE (LPN)
Entity Type:Individual
Prefix:
First Name:DALISA
Middle Name:RANELLE
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 1:7071 EASTLAWN DR
Mailing Address - Street 2:APT 1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-4125
Mailing Address - Country:US
Mailing Address - Phone:513-293-2116
Mailing Address - Fax:
Practice Address - Street 1:7071 EASTLAWN DR
Practice Address - Street 2:APT 1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-4125
Practice Address - Country:US
Practice Address - Phone:513-293-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-123128-IV164W00000X
KY2043497164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse