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NPI Code Detail

MEDICARE: MARY JEAN WALKER APRN

MEDICARE: MARY JEAN WALKER APRN
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
1363L00000XNurse Practitioner188868-4405UT

General Provider Information

NPI Number : 1508851890
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JEAN WALKER APRN
Provider Business Mailing Address
First Line : 5505 S 900 E STE 240
Second Line :
City : MURRAY
State : UT
Zip : 84117-7210
Country : US
Telephone Number : 17-835-0118
Fax Number : 801-746-3734
Provider Business Practice Location Address
First Line : 5505 S 900 E STE 240
Second Line :
City : MURRAY
State : UT
Zip : 84117-7210
Country : US
Telephone Number : 801-783-5011
Fax Number : 801-746-3734
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2005
Last Update Date : 01/23/2024

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