Provider Demographics
NPI:1982104691
Name:WALKER, AVERIL LANAN
Entity Type:Individual
Prefix:
First Name:AVERIL
Middle Name:LANAN
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 1:14853 BELL MANOR CT
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-4329
Mailing Address - Country:US
Mailing Address - Phone:469-254-4732
Mailing Address - Fax:
Practice Address - Street 1:14853 BELL MANOR CT
Practice Address - Street 2:
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-4329
Practice Address - Country:US
Practice Address - Phone:469-254-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX313782164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse