Healthcare Provider Details

I. General information

NPI: 1972853356
Provider Name (Legal Business Name): ERIN WALKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 08/25/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 KENMOOR AVE SE SUITE 103
GRAND RAPIDS MI
49546-8626
US

IV. Provider business mailing address

630 KENMOOR AVE SE SUITE 103
GRAND RAPIDS MI
49546-8626
US

V. Phone/Fax

Practice location:
  • Phone: 616-600-4950
  • Fax: 855-817-3028
Mailing address:
  • Phone: 616-600-4950
  • Fax: 855-817-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601006444
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: