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NPI Code Detail

MEDICARE: DIANE K WALKER RN CDE

MEDICARE: DIANE K WALKER RN CDE
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
1136A00000XRegistered Dietetic Technician90435 30WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
190435 30OTHERWIWI LICENSE

General Provider Information

NPI Number : 1710282678
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE K WALKER RN CDE
Provider Business Mailing Address
First Line : 1 N HILL ROAD
Second Line :
City : WAUSAU
State : WI
Zip : 54403
Country : US
Telephone Number : 715-478-5180
Fax Number : 715-478-5904
Provider Business Practice Location Address
First Line : 3144 VANZILE ROAD
Second Line :
City : CRANDON
State : WI
Zip : 54520-0275
Country : US
Telephone Number : 715-478-5180
Fax Number : 715-478-5904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2011
Last Update Date : 01/24/2011

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