Healthcare Provider Details

I. General information

NPI: 1245568286
Provider Name (Legal Business Name): LORI L WALKER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2009
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1823
US

IV. Provider business mailing address

1518 GIRARD BLVD NE
ALBUQUERQUE NM
87106-1823
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-3835
  • Fax: 505-266-3340
Mailing address:
  • Phone: 505-266-3835
  • Fax: 505-266-3340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCNP-01540
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: