MEDICARE: MS. EJIRIA TI-ISH WALKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	307504	AZ
2	164W00000X	Licensed Practical Nurse	LP50276	AZ
3	163WW0000X	Wound Care Registered Nurse	307504	AZ

General Provider Information

NPI Number	:	1336002583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EJIRIA TI-ISH WALKER

Provider Business Mailing Address
First Line	:	6520 W TORONTO WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-8533
Country	:	US
Telephone Number	:	602-775-6424
Fax Number	:	480-781-4566

Provider Business Practice Location Address
First Line	:	6520 W TORONTO WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85043-8533
Country	:	US
Telephone Number	:	602-775-6424
Fax Number	:	480-781-4566

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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