Provider Demographics
NPI:1811182074
Name:WALKER, MELISSA A (NP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:A
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:N17W24100 RIVERWOOD DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:725 AMERICAN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5031
Practice Address - Country:US
Practice Address - Phone:262-928-2570
Practice Address - Fax:262-928-5194
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI504-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI683750658Medicare PIN
WI68280Medicare PIN