Healthcare Provider Details

I. General information

NPI: 1982444147
Provider Name (Legal Business Name): SHAWNA WALKER RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6385 CORPORATE DR STE 100
COLORADO SPRINGS CO
80919-5912
US

IV. Provider business mailing address

145 EL DORADO LN
COLORADO SPRINGS CO
80919-2620
US

V. Phone/Fax

Practice location:
  • Phone: 749-785-3705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: