Healthcare Provider Details

I. General information

NPI: 1154312064
Provider Name (Legal Business Name): SAMARA WILLIAMS WALKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 576 JEFFERSON AVENUE MCDONALD ARMY COMMUNITY HOSPI
FORT EUSTIS VA
23604
US

IV. Provider business mailing address

15 RIDGE LAKE DR
HAMPTON VA
23666-1862
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7597
  • Fax: 757-314-7703
Mailing address:
  • Phone: 757-838-0788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001120977
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: