Provider Demographics
NPI:1851473110
Name:WALKER, JOHN ELLIOTT (MA RNC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ELLIOTT
Last Name:WALKER
Suffix:
Gender:M
Credentials:MA RNC
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 129
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-0129
Mailing Address - Country:US
Mailing Address - Phone:301-373-3065
Mailing Address - Fax:301-373-6143
Practice Address - Street 1:44101 AIRPORT VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636
Practice Address - Country:US
Practice Address - Phone:301-373-3065
Practice Address - Fax:301-373-6143
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR111829163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR111829OtherNURSING LICENSE
MD424P847GMedicare UPIN