Healthcare Provider Details

I. General information

NPI: 1518207745
Provider Name (Legal Business Name): ANDREA MARIE WALKER DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 WYE OAK DR
FRUITLAND MD
21826-1929
US

IV. Provider business mailing address

741 WYE OAK DR
FRUITLAND MD
21826-1929
US

V. Phone/Fax

Practice location:
  • Phone: 336-317-2202
  • Fax:
Mailing address:
  • Phone: 336-317-2202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5563
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: