MEDICARE: MRS. JACQUELINE LILLIAN WALKER-GARDNER M.S. ED

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	390200000X	Student in an Organized Health Care Education/Training Program	885891991	NY

General Provider Information

NPI Number	:	1346598687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELINE LILLIAN WALKER-GARDNER M.S. ED

Provider Business Mailing Address
First Line	:	3208 GUNTHER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-3112
Country	:	US
Telephone Number	:	347-449-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 GUNTHER AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-3112
Country	:	US
Telephone Number	:	347-449-5677
Fax Number	:

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

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	08/16/2012

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