Healthcare Provider Details

I. General information

NPI: 1194702688
Provider Name (Legal Business Name): STEPHEN HARVIE WALKER CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA, DIVISION OF CARDIO
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3400 CIVIC CENTER BLVD CHILDREN'S HOSPITAL OF PHILADELPHIA, DIVISION OF CARDIO
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-5248
  • Fax: 215-590-1340
Mailing address:
  • Phone: 215-590-5248
  • Fax: 215-590-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number26NC05789400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP010282
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: