MEDICARE: RENEE C WALKER

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	376K00000X	Nurse's Aide
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1235437989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE C WALKER

Provider Business Mailing Address
First Line	:	196 ARROWHEAD DRIVE
Second Line	:	SUITE 6
City	:	EVANSTON
State	:	WY
Zip	:	82930-5205
Country	:	US
Telephone Number	:	307-789-4224
Fax Number	:	307-789-4225

Provider Business Practice Location Address
First Line	:	75 YELLOW CREEK RD
Second Line	:	STE 105
City	:	EVANSTON
State	:	WY
Zip	:	82930-5235
Country	:	US
Telephone Number	:	307-789-4224
Fax Number	:	307-789-4225

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

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	01/19/2012

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Directions to “ RENEE C WALKER ” Practice Location

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