Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN279876 | MA |
NPI | 1003330028 |
---|---|
Provider Name | Mr. Mark James Walker |
First Address | Chelmsford, MA 01824-3346 |
Second Address | Lawrence, MA 01841-2961 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2017 |
Last Update Date | 17/09/2017 |