Healthcare Provider Details

I. General information

NPI: 1588171805
Provider Name (Legal Business Name): MONICA LYNN WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 NW 188TH AVE STE 200
HILLSBORO OR
97006-6465
US

IV. Provider business mailing address

2655 NW OVERLOOK DR APT 1233
HILLSBORO OR
97124-7631
US

V. Phone/Fax

Practice location:
  • Phone: 503-720-1609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: