Provider Demographics
NPI:1619659968
Name:WALKER, DANAE LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:DANAE
Middle Name:LEE
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 E 800 N
Mailing Address - Street 2:
Mailing Address - City:MENAN
Mailing Address - State:ID
Mailing Address - Zip Code:83434
Mailing Address - Country:US
Mailing Address - Phone:208-709-1920
Mailing Address - Fax:
Practice Address - Street 1:1880 JOHN ADAMS PARKWAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-524-6633
Practice Address - Fax:208-528-2978
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID77208363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily