Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD.201211 | LA |
Y | 2080P0204X | Pediatric Emergency Doctor | MD.201211 | LA |
NPI | 1245400100 |
---|---|
Provider Name | Brandi Adele Walker |
First Address | Harahan, LA 70123-4610 |
Second Address | New Orleans, LA 70118-5720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2008 |
Last Update Date | 09/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1238112 | (05) | LA |
MD.201211 | STATE LICENSE NUMBER (01) | LA |