Provider Demographics
NPI:1306452750
Name:WALKER, DENITA SEREE
Entity type:Individual
Prefix:MRS
First Name:DENITA
Middle Name:SEREE
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 1:100 S 5TH ST STE 1900
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402-1267
Mailing Address - Country:US
Mailing Address - Phone:763-501-0792
Mailing Address - Fax:
Practice Address - Street 1:100 S 5TH ST STE 1900
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-1267
Practice Address - Country:US
Practice Address - Phone:763-501-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29834287003747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2983428700OtherPCA