Provider Demographics
NPI:1326771734
Name:WALKER, IRENE BALA (APN, FNP-C)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:BALA
Last Name:WALKER
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:NJ
Mailing Address - Zip Code:07628-1901
Mailing Address - Country:US
Mailing Address - Phone:845-222-1643
Mailing Address - Fax:
Practice Address - Street 1:66 N RTE 17 STE 250
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2742
Practice Address - Country:US
Practice Address - Phone:201-368-2222
Practice Address - Fax:201-368-2223
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2024-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01351600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily