Healthcare Provider Details

I. General information

NPI: 1841887270
Provider Name (Legal Business Name): TIMOTHY WILLIAM WALKOWIAK NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2020
Last Update Date: 12/31/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 W THOMAS RD
PHOENIX AZ
85037-3234
US

IV. Provider business mailing address

4220 N 20TH AVE
PHOENIX AZ
85015-5124
US

V. Phone/Fax

Practice location:
  • Phone: 602-889-9401
  • Fax: 602-889-9404
Mailing address:
  • Phone: 602-889-9401
  • Fax: 602-889-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTEMP251658
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: