Provider Demographics
NPI:1982118477
Name:WALKER, LISA A (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BENSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2916
Mailing Address - Country:US
Mailing Address - Phone:631-589-1483
Mailing Address - Fax:
Practice Address - Street 1:100 GREENE AVE
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2723
Practice Address - Country:US
Practice Address - Phone:631-567-8518
Practice Address - Fax:631-218-5158
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY441662-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY441662-1Medicaid