Healthcare Provider Details

I. General information

NPI: 1659913598
Provider Name (Legal Business Name): ANGELA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 LA SALLE AVE
SAINT JOSEPH MI
49085-1630
US

IV. Provider business mailing address

543 LA SALLE AVE
SAINT JOSEPH MI
49085-1630
US

V. Phone/Fax

Practice location:
  • Phone: 269-325-5389
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801105876
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: