Provider Demographics
NPI:1265029979
Name:WALKER, JONATHAN (CERTIFIED PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:CERTIFIED PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7342 DEER TRAIL CT
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2647
Mailing Address - Country:US
Mailing Address - Phone:567-277-4601
Mailing Address - Fax:
Practice Address - Street 1:7342 DEER TRAIL CT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2647
Practice Address - Country:US
Practice Address - Phone:567-277-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker