Healthcare Provider Details

I. General information

NPI: 1063607497
Provider Name (Legal Business Name): NATALIE L WALKUP PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 HARROUN RD # 285
SYLVANIA OH
43560-2193
US

IV. Provider business mailing address

100 MADISON AVE
TOLEDO OH
43604-1516
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-5633
  • Fax: 419-824-5953
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50002648
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: