Provider Demographics
NPI:1386702967
Name:WALKER, MARIE F (NP)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:F
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2904
Mailing Address - Country:US
Mailing Address - Phone:602-952-3400
Mailing Address - Fax:602-952-3401
Practice Address - Street 1:8836 N 23RD AVE STE B1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4175
Practice Address - Country:US
Practice Address - Phone:602-944-9810
Practice Address - Fax:602-944-1547
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP6011363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ464454Medicaid
AZ464454Medicaid
AZ102541Medicare ID - Type Unspecified