Provider Demographics
NPI:1619678422
Name:WALKER, ADRIENNE DIMETRA (CRNP)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:DIMETRA
Last Name:WALKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:DIMETRA
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:811 SCHOOL LN
Mailing Address - Street 2:
Mailing Address - City:FOLCROFT
Mailing Address - State:PA
Mailing Address - Zip Code:19032-1816
Mailing Address - Country:US
Mailing Address - Phone:484-639-3613
Mailing Address - Fax:
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027321363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics