Healthcare Provider Details

I. General information

NPI: 1508584764
Provider Name (Legal Business Name): HEATHER WALKER CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 STODDERT AVE
WALDORF MD
20602-2916
US

IV. Provider business mailing address

1009 STODDERT AVE
WALDORF MD
20602-2916
US

V. Phone/Fax

Practice location:
  • Phone: 301-789-8336
  • Fax:
Mailing address:
  • Phone: 301-789-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000191
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: