Healthcare Provider Details

I. General information

NPI: 1497196943
Provider Name (Legal Business Name): DIANA E WALKER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 SKY POINTE DR STE 110
LAS VEGAS NV
89131-4052
US

IV. Provider business mailing address

6420 SKY POINTE DR STE 110
LAS VEGAS NV
89131-4052
US

V. Phone/Fax

Practice location:
  • Phone: 702-778-9771
  • Fax: 800-879-8138
Mailing address:
  • Phone: 702-778-9771
  • Fax: 800-879-8138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA WALKER
Title or Position: OWNER
Credential:
Phone: 702-778-9771