Provider Demographics
NPI:1225324007
Name:WALKER, BRENDA MAUD (RN)
Entity Type:Individual
Prefix:MISS
First Name:BRENDA
Middle Name:MAUD
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11727 193RD ST
Mailing Address - Street 2:PH
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3305
Mailing Address - Country:US
Mailing Address - Phone:917-515-0877
Mailing Address - Fax:
Practice Address - Street 1:11727 193RD ST
Practice Address - Street 2:PH
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3305
Practice Address - Country:US
Practice Address - Phone:917-515-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY638197-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse