Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 305259 | NY |
NPI | 1023545977 |
---|---|
Provider Name | Ms. Tanya K. Walker |
First Address | Laurelton, NY 11413-1838 |
Second Address | Flushing, NY 11354-4236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2017 |
Last Update Date | 22/05/2017 |