Provider Demographics
NPI:1487003992
Name:WALK, MELODY
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:WALK
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 1:1117 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2558
Mailing Address - Country:US
Mailing Address - Phone:989-791-4020
Mailing Address - Fax:989-921-8765
Practice Address - Street 1:1117 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2558
Practice Address - Country:US
Practice Address - Phone:989-791-4020
Practice Address - Fax:989-921-8765
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704244946363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health