Healthcare Provider Details

I. General information

NPI: 1285516807
Provider Name (Legal Business Name): DEBORAH HENRY-WALKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9928 SOUTH LASALLE STREET
CHICAGO IL
60628-1312
US

IV. Provider business mailing address

9928 SOUTH LASALLE STREET
CHICAGO IL
60628-1312
US

V. Phone/Fax

Practice location:
  • Phone: 773-507-1447
  • Fax:
Mailing address:
  • Phone: 773-507-1447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033581
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041329125
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: