Provider Demographics
NPI:1508584764
Name:WALKER, HEATHER (CPM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 STODDERT AVE
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2916
Mailing Address - Country:US
Mailing Address - Phone:301-789-8336
Mailing Address - Fax:
Practice Address - Street 1:1009 STODDERT AVE
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2916
Practice Address - Country:US
Practice Address - Phone:301-789-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X, 374J00000X
VA0129000191176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty