Provider Demographics
NPI:1326280249
Name:WALKER, JUDY ROCHELLE (RN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ROCHELLE
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:PO BOX 1354
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-1354
Mailing Address - Country:US
Mailing Address - Phone:562-424-4815
Mailing Address - Fax:562-424-4688
Practice Address - Street 1:2880 ATLANTIC AVE
Practice Address - Street 2:STE 255
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1714
Practice Address - Country:US
Practice Address - Phone:562-424-4815
Practice Address - Fax:562-424-4688
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268896163W00000X
CA32911163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32911OtherPUBIC HEALTH NURSE
CA268896OtherREGISTERED NURSE