Healthcare Provider Details

I. General information

NPI: 1114119062
Provider Name (Legal Business Name): THERESA F. WALKER SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9008 NE 102ND ST
VANCOUVER WA
98662-1426
US

IV. Provider business mailing address

9008 NE 102ND ST
VANCOUVER WA
98662-1426
US

V. Phone/Fax

Practice location:
  • Phone: 360-567-8143
  • Fax:
Mailing address:
  • Phone: 360-567-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: