Provider Demographics
NPI:1275802563
Name:WALKER, STEPHANIE IVETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:IVETTE
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BRONX PARK E
Mailing Address - Street 2:APT.13I
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6711
Mailing Address - Country:US
Mailing Address - Phone:718-216-8997
Mailing Address - Fax:
Practice Address - Street 1:3000 BRONX PARK E
Practice Address - Street 2:APT.13I
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-6711
Practice Address - Country:US
Practice Address - Phone:718-216-8997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2024-12-12
Deactivation Date:2020-12-15
Deactivation Code:
Reactivation Date:2024-12-12
Provider Licenses
StateLicense IDTaxonomies
NY650059163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse