Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RN121512-AP06572 | LA |
NPI | 1093093056 |
---|---|
Provider Name | Shanah Denise Walker |
First Address | Shreveport, LA 71118-3136 |
Second Address | Shreveport, LA 71118-3136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 27/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2158775 | (05) | LA |