MEDICARE: DUCHESS M WALKER RN, WTA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WW0000X	Wound Care Registered Nurse	2471869	MN

General Provider Information

NPI Number	:	1174154322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUCHESS M WALKER RN, WTA-C

Provider Business Mailing Address
First Line	:	4546 58TH AVE N APT 345
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-2953
Country	:	US
Telephone Number	:	763-516-4851
Fax Number	:

Provider Business Practice Location Address
First Line	:	4546 58TH AVE N APT 345
Second Line	:
City	:	BROOKLYN CENTER
State	:	MN
Zip	:	55429-2953
Country	:	US
Telephone Number	:	763-516-4851
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	01/27/2020

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