Healthcare Provider Details

I. General information

NPI: 1346540374
Provider Name (Legal Business Name): MICHELLE MARIE WALKER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3807 FRIENDSVILLE RD
WOOSTER OH
44691-9601
US

IV. Provider business mailing address

1045 W HIGH AVE
NEW PHILADELPHIA OH
44663-2071
US

V. Phone/Fax

Practice location:
  • Phone: 330-345-1100
  • Fax:
Mailing address:
  • Phone: 330-308-5432
  • Fax: 330-339-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP-11594
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.111594
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: