Provider Demographics
NPI:1114119062
Name:WALKER, THERESA F (SA-C)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:F
Last Name:WALKER
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9008 NE 102ND ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-1426
Mailing Address - Country:US
Mailing Address - Phone:360-567-8143
Mailing Address - Fax:
Practice Address - Street 1:9008 NE 102ND ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-1426
Practice Address - Country:US
Practice Address - Phone:360-567-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist