Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036091690 | IL |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 36091690 | IL |
NPI | 1073563821 |
---|---|
Provider Name | Dr. Jacqueline Walker |
First Address | Westchester, IL 60154-5634 |
Second Address | Westchester, IL 60154-5634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 19/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036091960 | (05) | IL |