MEDICARE: MARQUIE L. 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	385HR2055X	Child Mental Illness Respite Care	7906938	AZ

General Provider Information

NPI Number	:	1619492121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUIE L. WALKER

Provider Business Mailing Address
First Line	:	5121 E 29TH ST APT 125
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-5802
Country	:	US
Telephone Number	:	520-891-3577
Fax Number	:

Provider Business Practice Location Address
First Line	:	5121 E 29TH ST APT 125
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-5802
Country	:	US
Telephone Number	:	520-891-3577
Fax Number	:

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

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	07/21/2022

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