Provider Demographics
NPI:1881044774
Name:GREEN-WALKER, AJA
Entity Type:Individual
Prefix:
First Name:AJA
Middle Name:
Last Name:GREEN-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 1:16970 CHANDLER RD
Mailing Address - Street 2:APT 3204
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6101
Mailing Address - Country:US
Mailing Address - Phone:248-497-7900
Mailing Address - Fax:
Practice Address - Street 1:2775 E LANSING DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7755
Practice Address - Country:US
Practice Address - Phone:517-332-1616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner