Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 25MA07905600 | NJ |
NPI | 1003836123 |
---|---|
Provider Name | Tracy Lynne Walker |
First Address | Boston, MA 02241-9430 |
Second Address | Emerson, NJ 07630-1368 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 18/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I49304 | (02) | NJ |