Basic Information
| Provider Information | |||||||||
| NPI: | 1386702967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3003 N CENTRAL AVE STE 305 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029523400 | ||||||||
| FaxNumber: | 6029523401 | ||||||||
| Practice Location | |||||||||
| Address1: | 8836 N 23RD AVE STE B1 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850214175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029449810 | ||||||||
| FaxNumber: | 6029441547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 01/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP6011 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 464454 | 05 | AZ | MEDICAID |