Provider Demographics
NPI:1093994188
Name:WALKER, VICTORIA EA (NP)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:EA
Last Name:WALKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:180 SAND RUN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6064
Mailing Address - Country:US
Mailing Address - Phone:330-388-8329
Mailing Address - Fax:
Practice Address - Street 1:4040 EMBASSY PKWY
Practice Address - Street 2:IMS SUITE 400
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8326
Practice Address - Country:US
Practice Address - Phone:330-576-0500
Practice Address - Fax:330-576-0467
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266657363L00000X
OHCOA.14404-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000324502Medicare PIN
000324501Medicare PIN