Provider Demographics
NPI:1144936709
Name:WALIZER, JONDA KAYE
Entity type:Individual
Prefix:
First Name:JONDA
Middle Name:KAYE
Last Name:WALIZER
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 1:929 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-3517
Mailing Address - Country:US
Mailing Address - Phone:931-652-2762
Mailing Address - Fax:
Practice Address - Street 1:244 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LYNNVILLE
Practice Address - State:TN
Practice Address - Zip Code:38472-3115
Practice Address - Country:US
Practice Address - Phone:919-649-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider