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General NPI Number Information
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NPI Number | 1760433601
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Entity Type | Individual
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Provider Name | ELOISA S. WALKER MD
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 100 E IDAHO ST SUITE 304
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City | BOISE
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State | ID
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Zip | 83712-6223
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Country | US
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Telephone | 208-336-9188
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Fax | 208-336-2636
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712
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Country | US
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Telephone | 208-337-4254
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Fax | 208-337-4328
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | M6279
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License Number State | ID
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