Provider Demographics
NPI:1235437989
Name:WALKER, RENEE C
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:C
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 1:196 ARROWHEAD DRIVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5205
Mailing Address - Country:US
Mailing Address - Phone:307-789-4224
Mailing Address - Fax:307-789-4225
Practice Address - Street 1:75 YELLOW CREEK RD
Practice Address - Street 2:STE 105
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-5235
Practice Address - Country:US
Practice Address - Phone:307-789-4224
Practice Address - Fax:307-789-4225
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172V00000XOther Service ProvidersCommunity Health Worker