Provider Demographics
NPI:1194754614
Name:WALKER, MARIBETH -
Entity type:Individual
Prefix:MRS
First Name:MARIBETH
Middle Name:-
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 ANDERSON AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-8625
Mailing Address - Country:US
Mailing Address - Phone:330-862-2265
Mailing Address - Fax:
Practice Address - Street 1:3555 ANDERSON AVE NE
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-8625
Practice Address - Country:US
Practice Address - Phone:330-862-2265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2646908Medicaid