1275802563 NPI number — MRS. STEPHANIE IVETTE WALKER R.N.

Table of content: MRS. STEPHANIE IVETTE WALKER R.N. (NPI 1275802563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275802563 NPI number — MRS. STEPHANIE IVETTE WALKER R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
STEPHANIE
Provider Middle Name:
IVETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275802563
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/15/2020
NPI Reactivation Date:
12/12/2024

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3000 BRONX PARK E
Provider Second Line Business Mailing Address:
APT.13I
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10467-6711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-216-8997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 BRONX PARK E
Provider Second Line Business Practice Location Address:
APT.13I
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10467-6711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-216-8997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  650059 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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