Healthcare Provider Details

I. General information

NPI: 1942351192
Provider Name (Legal Business Name): SUSAN M WALKER NP C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WASHINGTON ST 3RD FLOOR SAMARITAN MEDICAL CENTER PMC
WATERTOWN NY
13601-3211
US

IV. Provider business mailing address

104 PADDOCK ST PO BOX 779
WATERTOWN NY
13601-0779
US

V. Phone/Fax

Practice location:
  • Phone: 315-785-4313
  • Fax: 315-779-5114
Mailing address:
  • Phone: 315-785-8509
  • Fax: 315-779-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF3330871
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: