Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2005-01198 | NC |
N | 2080A0000X | Adolescent Medicine | 2005-01198 | NC |
NPI | 1174518427 |
---|---|
Provider Name | Dr. Constance E Walker |
First Address | Gastonia, NC 28054-4839 |
Second Address | Gastonia, NC 28054-4839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 09/09/2011 |