MEDICARE: MISS SANDRA KAYE WALKER RN

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	163W00000X	Registered Nurse	RN318397	OH

General Provider Information

NPI Number	:	1356618219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANDRA KAYE WALKER RN

Provider Business Mailing Address
First Line	:	1368 CRANFORD AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2310
Country	:	US
Telephone Number	:	216-404-8566
Fax Number	:

Provider Business Practice Location Address
First Line	:	1368 CRANFORD AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-2310
Country	:	US
Telephone Number	:	216-404-8566
Fax Number	:

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

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	11/21/2011

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