1043382823 NPI number — BRENDA ANNE WALKER-MEHLERT CERTIFIED THERAPEUTI

Table of content: BRENDA ANNE WALKER-MEHLERT CERTIFIED THERAPEUTI (NPI 1043382823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043382823 NPI number — BRENDA ANNE WALKER-MEHLERT CERTIFIED THERAPEUTI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER-MEHLERT
Provider First Name:
BRENDA
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CERTIFIED THERAPEUTI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WALKER
Provider Other First Name:
BRENDA
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043382823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3013 W GRANDVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-277-5551
Provider Business Mailing Address Fax Number:
602-200-6039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 E INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
CARL T HAYDEN VAMC
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-277-5551
Provider Business Practice Location Address Fax Number:
602-200-6039
Provider Enumeration Date:
11/15/2006

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: 225800000X , with the licence number:  28847 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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