Provider Demographics
NPI:1770823478
Name:WALKER, BRUCE
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7041 KNOB CREEK ST
Mailing Address - Street 2:103
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3198
Mailing Address - Country:US
Mailing Address - Phone:702-998-7660
Mailing Address - Fax:
Practice Address - Street 1:7041 KNOB CREEK ST
Practice Address - Street 2:103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3198
Practice Address - Country:US
Practice Address - Phone:702-998-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency