Healthcare Provider Details

I. General information

NPI: 1699761619
Provider Name (Legal Business Name): MARY ANNE WALKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST. SUITE 504B
SALISBURY MD
21804-6958
US

IV. Provider business mailing address

106 MILFORD ST SUITE 504B
SALISBURY MD
21804-6953
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-5954
  • Fax: 410-219-3038
Mailing address:
  • Phone: 410-546-5954
  • Fax: 410-219-3038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR063517
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR063517
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: