MEDICARE: CISSIE L WALKER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN135266	GA
2	367500000X	Certified Registered Nurse Anesthetist	719268	TX
3	367500000X	Certified Registered Nurse Anesthetist	CRNA000322	NV

General Provider Information

NPI Number	:	1891763462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CISSIE L WALKER CRNA

Provider Business Mailing Address
First Line	:	3835 S JONES BLVD
Second Line	:	SUITE 104
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-7125
Country	:	US
Telephone Number	:	702-880-4193
Fax Number	:	702-880-4197

Provider Business Practice Location Address
First Line	:	6950 S CIMARRON RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2135
Country	:	US
Telephone Number	:	702-796-0231
Fax Number	:	702-796-5211

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	04/25/2019

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