Provider Demographics
NPI:1780026286
Name:WALKER, TANI (RN)
Entity Type:Individual
Prefix:MS
First Name:TANI
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-0874
Mailing Address - Country:US
Mailing Address - Phone:360-446-6636
Mailing Address - Fax:360-446-6636
Practice Address - Street 1:16819 JONAS HILL LN SE
Practice Address - Street 2:
Practice Address - City:RAINIER
Practice Address - State:WA
Practice Address - Zip Code:98576-9669
Practice Address - Country:US
Practice Address - Phone:360-446-6636
Practice Address - Fax:360-446-6636
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00091635163W00000X, 310400000X
WARN000091635310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility