Healthcare Provider Details

I. General information

NPI: 1619092764
Provider Name (Legal Business Name): DUANA MARIE WALTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 28TH ST SUITE 40
MINNEAPOLIS MN
55407-1139
US

IV. Provider business mailing address

1020 W MEDICINE LAKE DR APT 313
PLYMOUTH MN
55441-4513
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-3941
  • Fax: 612-863-2490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 106980-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: