Provider Demographics
NPI:1881958403
Name:WALKER, CYNTHIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:WALKER-NAVEDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:35 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3410
Mailing Address - Country:US
Mailing Address - Phone:631-894-6624
Mailing Address - Fax:631-357-3386
Practice Address - Street 1:35 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-3410
Practice Address - Country:US
Practice Address - Phone:631-894-6624
Practice Address - Fax:631-357-3386
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274631-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse