Provider Demographics
NPI:1710959564
Name:WALKER, CHRISTINE A (CNM)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:A
Last Name:WALKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:WALKER-LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1005 WALNUT ST.
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901
Mailing Address - Country:US
Mailing Address - Phone:607-734-3960
Mailing Address - Fax:607-734-4554
Practice Address - Street 1:1005 WALNUT ST.
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901
Practice Address - Country:US
Practice Address - Phone:607-734-3960
Practice Address - Fax:607-734-4554
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO107176367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07107170Medicaid
CO07107170Medicaid
CO402168Medicare ID - Type Unspecified