MEDICARE: SUSAN M WALKER NP C

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	363LF0000X	Family Nurse Practitioner	F3330871	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942351192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M WALKER NP C

Provider Business Mailing Address
First Line	:	104 PADDOCK ST
Second Line	:	PO BOX 779
City	:	WATERTOWN
State	:	NY
Zip	:	13601-0779
Country	:	US
Telephone Number	:	315-785-8509
Fax Number	:	315-779-5114

Provider Business Practice Location Address
First Line	:	830 WASHINGTON ST 3RD FLOOR
Second Line	:	SAMARITAN MEDICAL CENTER PMC
City	:	WATERTOWN
State	:	NY
Zip	:	13601-3211
Country	:	US
Telephone Number	:	315-785-4313
Fax Number	:	315-779-5114

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	05/20/2008

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