Healthcare Provider Details

I. General information

NPI: 1184058539
Provider Name (Legal Business Name): JILL M WALKER M.AC., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2013
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17700 WHITE GROUND RD
BOYDS MD
20841-9427
US

IV. Provider business mailing address

17700 WHITE GROUND RD
BOYDS MD
20841-9427
US

V. Phone/Fax

Practice location:
  • Phone: 240-477-3435
  • Fax:
Mailing address:
  • Phone: 240-477-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02068
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: