Provider Demographics
NPI:1710450465
Name:WALKER, MALINDA
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:
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 1:109 LUCY THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-0315
Mailing Address - Country:US
Mailing Address - Phone:702-917-9519
Mailing Address - Fax:
Practice Address - Street 1:4550 W OAKEY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1506
Practice Address - Country:US
Practice Address - Phone:702-906-1999
Practice Address - Fax:702-906-1998
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant