1104985043 NPI number — MRS. MOLLY VIRGINIA WALKER RN, CNM, MSN

Table of content: MRS. MOLLY VIRGINIA WALKER RN, CNM, MSN (NPI 1104985043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104985043 NPI number — MRS. MOLLY VIRGINIA WALKER RN, CNM, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALKER
Provider First Name:
MOLLY
Provider Middle Name:
VIRGINIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CNM, MSN
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:
1104985043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 PAULETTE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREEHOLD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07728-8149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-462-8139
Provider Business Mailing Address Fax Number:
732-303-6009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HORIZON HEALTH CENTER
Provider Second Line Business Practice Location Address:
714 BERGEN AVENUE
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-451-6300
Provider Business Practice Location Address Fax Number:
201-451-0619
Provider Enumeration Date:
12/06/2006

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: 163W00000X , with the licence number:  26NR005762600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: 25ME00014001 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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