Provider Demographics
NPI:1902479835
Name:WALKER, LAODECIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LAODECIA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28264 SPRING CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-9382
Mailing Address - Country:US
Mailing Address - Phone:951-575-5115
Mailing Address - Fax:
Practice Address - Street 1:28264 SPRING CREEK WAY
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9382
Practice Address - Country:US
Practice Address - Phone:951-415-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378812163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty