Provider Demographics
NPI:1689814170
Name:WALKER, SHANNON LYNN (RD, CDE)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S DOWNING ST
Mailing Address - Street 2:PORTER ADVENTIST HOSPITAL/DIABETES EDUCATION
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5817
Mailing Address - Country:US
Mailing Address - Phone:303-765-6431
Mailing Address - Fax:303-778-5214
Practice Address - Street 1:2525 S DOWNING ST
Practice Address - Street 2:PORTER ADVENTIST HOSPITAL/DIABETES EDUCATION
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5817
Practice Address - Country:US
Practice Address - Phone:303-765-6431
Practice Address - Fax:303-778-5214
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered