Provider Demographics
NPI:1528563830
Name:WALKER, RENEE LILLIAN
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:LILLIAN
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 1:8045 PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55795-9782
Mailing Address - Country:US
Mailing Address - Phone:651-245-3160
Mailing Address - Fax:
Practice Address - Street 1:8045 PARK DR
Practice Address - Street 2:
Practice Address - City:WILLOW RIVER
Practice Address - State:MN
Practice Address - Zip Code:55795-9782
Practice Address - Country:US
Practice Address - Phone:651-245-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR141217-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse