Provider Demographics
NPI:1619492121
Name:WALKER, MARQUIE L
Entity Type:Individual
Prefix:
First Name:MARQUIE
Middle Name:L
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 1:5121 E 29TH ST APT 125
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-5802
Mailing Address - Country:US
Mailing Address - Phone:520-891-3577
Mailing Address - Fax:
Practice Address - Street 1:5121 E 29TH ST APT 125
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-5802
Practice Address - Country:US
Practice Address - Phone:520-891-3577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7906938385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child