Provider Demographics
NPI:1356657225
Name:WALKER-HOWARD, TAMICIA MONIQUE (STNA)
Entity Type:Individual
Prefix:
First Name:TAMICIA
Middle Name:MONIQUE
Last Name:WALKER-HOWARD
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 SANDALWOOD PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3600
Mailing Address - Country:US
Mailing Address - Phone:614-572-1751
Mailing Address - Fax:
Practice Address - Street 1:1812 SANDALWOOD PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3600
Practice Address - Country:US
Practice Address - Phone:614-572-1751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401122240710374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401122240710Medicaid