Provider Demographics
NPI:1528769155
Name:WALLS, ALICIA (HOME AID)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WALLS
Suffix:
Gender:F
Credentials:HOME AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4618 LIVINGSTON RD SE APT 104
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3140
Mailing Address - Country:US
Mailing Address - Phone:301-793-7657
Mailing Address - Fax:
Practice Address - Street 1:4000 BENNING RD NE APT 207
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3471
Practice Address - Country:US
Practice Address - Phone:202-651-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant