Provider Demographics
NPI:1497185839
Name:WALKER, ELAINE HANGLEN
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:HANGLEN
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 1:136 N CHESTNUT ST APT 19C
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1020
Mailing Address - Country:US
Mailing Address - Phone:845-518-8661
Mailing Address - Fax:
Practice Address - Street 1:4 JEFFERSON PLZ STE 201
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4057
Practice Address - Country:US
Practice Address - Phone:845-473-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294719-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse