Provider Demographics
NPI:1093532558
Name:WALKER, TITECA MICHELLE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:TITECA
Middle Name:MICHELLE
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 1:244 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3404
Mailing Address - Country:US
Mailing Address - Phone:716-831-7877
Mailing Address - Fax:716-831-8666
Practice Address - Street 1:244 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-3404
Practice Address - Country:US
Practice Address - Phone:716-831-7877
Practice Address - Fax:716-831-8666
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY764626-01163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse