Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 023916 | LA |
NPI | 1013939560 |
---|---|
Provider Name | Candace Lynn Walkley |
First Address | Colorado Springs, CO 80917-5907 |
Second Address | Colorado Springs, CO 80917-5907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 13/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1487538 | (05) | LA |
H96559 | (02) | LA |