Provider Demographics
NPI:1104962844
Name:GOUDGE WALKER, CHRISTINE SUZANNE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:SUZANNE
Last Name:GOUDGE WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15800 95TH AVE N
Mailing Address - Street 2:PARK NICOLLET - DEPT OF OB/GYN
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-4400
Mailing Address - Country:US
Mailing Address - Phone:952-993-3282
Mailing Address - Fax:
Practice Address - Street 1:15800 95TH AVE N
Practice Address - Street 2:PARK NICOLLET - DEPT OF OB/GYN
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4400
Practice Address - Country:US
Practice Address - Phone:952-993-3282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16950207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34793800Medicaid
MN712452000Medicaid
MN160002720Medicare PIN
WI34793800Medicaid