Provider Demographics
NPI:1982387437
Name:WALTON, LAWANNA NACOLE (CNA)
Entity Type:Individual
Prefix:
First Name:LAWANNA
Middle Name:NACOLE
Last Name:WALTON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 LUCILLE LN
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36426-5113
Mailing Address - Country:US
Mailing Address - Phone:251-363-4983
Mailing Address - Fax:
Practice Address - Street 1:148 LUCILLE LN
Practice Address - Street 2:
Practice Address - City:BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-5113
Practice Address - Country:US
Practice Address - Phone:251-363-4983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty