Provider Demographics
NPI:1467770891
Name:WALKER, DAWN M
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
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 1:1010 RT 112
Mailing Address - Street 2:(ALL METRO HEALTH CARE)
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-473-1200
Mailing Address - Fax:631-473-3592
Practice Address - Street 1:1010 RT 112
Practice Address - Street 2:(ALL METRO HEALTH CARE)
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-473-1200
Practice Address - Fax:631-473-3592
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238570-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse