Healthcare Provider Details

I. General information

NPI: 1659533487
Provider Name (Legal Business Name): MELISSA BREI WALKER R.N., A.P.N., C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 RINGWOOD AVE THE WANAQUE CENTER FOR NURSING AND REHABILITATION
HASKELL NJ
07420-1520
US

IV. Provider business mailing address

1433 RINGWOOD AVE THE WANAQUE CENTER FOR NURSING AND REHABILITATION
HASKELL NJ
07420-1520
US

V. Phone/Fax

Practice location:
  • Phone: 973-839-2119
  • Fax: 913-839-2319
Mailing address:
  • Phone: 973-839-2119
  • Fax: 913-839-2319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00164000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: