Provider Demographics
NPI:1295847523
Name:WALKER, MARYBETH (APRN BC)
Entity Type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ALPRILLA FARM RD
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1922
Mailing Address - Country:US
Mailing Address - Phone:508-435-5513
Mailing Address - Fax:
Practice Address - Street 1:133 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-2630
Practice Address - Country:US
Practice Address - Phone:508-480-0092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170407364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWA NS0090Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE