Provider Demographics
NPI:1699761619
Name:WALKER, MARY ANNE (CRNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MILFORD ST
Mailing Address - Street 2:SUITE 504B
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6953
Mailing Address - Country:US
Mailing Address - Phone:410-546-5954
Mailing Address - Fax:410-219-3038
Practice Address - Street 1:106 MILFORD ST.
Practice Address - Street 2:SUITE 504B
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6958
Practice Address - Country:US
Practice Address - Phone:410-546-5954
Practice Address - Fax:410-219-3038
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR063517363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD774800100Medicaid
MD836LMedicare ID - Type Unspecified