MEDICARE: MS. SANDRA ANDERSON WALKER RN

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	163WG0000X	General Practice Registered Nurse	236180-1	NY

General Provider Information

NPI Number	:	1659689735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA ANDERSON WALKER RN

Provider Business Mailing Address
First Line	:	68 CENTRAL AVE
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-3016
Country	:	US
Telephone Number	:	631-681-8475
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 CENTRAL AVE
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-3016
Country	:	US
Telephone Number	:	631-681-8475
Fax Number	:

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

Provider Enumeration Date	:	09/22/2010
Last Update Date	:	09/22/2010

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