Provider Demographics
NPI:1003400037
Name:WALKER, MILLICENT YVONNE
Entity Type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:YVONNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 VAN WYCK EXPY
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2229
Mailing Address - Country:US
Mailing Address - Phone:718-322-3455
Mailing Address - Fax:
Practice Address - Street 1:11440 VAN WYCK EXPY
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2229
Practice Address - Country:US
Practice Address - Phone:718-322-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685865-01163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)