=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861474041
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE A WALKER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2005
-----------------------------------------------------
Last Update Date | 04/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2223 LIME KILN RD STE 1
-----------------------------------------------------
City | GREEN BAY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54311-6238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-430-8113
-----------------------------------------------------
Fax | 920-430-8122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2223 LIME KILN RD STE 1
-----------------------------------------------------
City | GREEN BAY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54311-6238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-430-8113
-----------------------------------------------------
Fax | 920-430-8122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 74007-020
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 036113195
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------