Provider Demographics
NPI:1003119116
Name:AKWO, WALTER
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:
Last Name:AKWO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 COLONIAL WAY APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4311
Mailing Address - Country:US
Mailing Address - Phone:408-806-3840
Mailing Address - Fax:
Practice Address - Street 1:10710 EVERGREEN WAY APT G207
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-4332
Practice Address - Country:US
Practice Address - Phone:408-806-3840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1053215363LP0808X
WAAP61256413363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health