Provider Demographics
NPI:1174154322
Name:WALKER, DUCHESS M (RN, WTA-C)
Entity type:Individual
Prefix:
First Name:DUCHESS
Middle Name:M
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN, WTA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4546 58TH AVE N APT 345
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-2953
Mailing Address - Country:US
Mailing Address - Phone:763-516-4851
Mailing Address - Fax:
Practice Address - Street 1:4546 58TH AVE N APT 345
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-2953
Practice Address - Country:US
Practice Address - Phone:763-516-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2471869163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty