Provider Demographics
NPI:1477956431
Name:WALKER, KAWANIS (CNA)
Entity Type:Individual
Prefix:
First Name:KAWANIS
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-2028
Mailing Address - Country:US
Mailing Address - Phone:240-772-8927
Mailing Address - Fax:
Practice Address - Street 1:5801 COOLIDGE ST
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-2028
Practice Address - Country:US
Practice Address - Phone:240-772-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00137975376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide