Healthcare Provider Details

I. General information

NPI: 1730182353
Provider Name (Legal Business Name): CHERYL A WALKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HERON RD
MYSTIC CT
06355-3253
US

IV. Provider business mailing address

3 HERON RD
MYSTIC CT
06355-3253
US

V. Phone/Fax

Practice location:
  • Phone: 860-536-6442
  • Fax: 860-536-6442
Mailing address:
  • Phone: 860-536-6442
  • Fax: 860-536-6442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number022943
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: