1083310528 NPI number — DAPHNE OPHELIA WALKER

Table of content: DAPHNE OPHELIA WALKER (NPI 1083310528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083310528 NPI number — DAPHNE OPHELIA WALKER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
DAPHNE
Provider Middle Name:
OPHELIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1083310528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8444 N 90TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-4437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-977-1438
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14300 E EXPOSITION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-2542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-853-4230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2023

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: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ACC.0005219 . This is a "COLORADO DIVISION OF PROFESSIONS AND OCCUPATIONS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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