Provider Demographics
NPI:1356718126
Name:WALKER-RICHARDS, PETER BENJAMIN (RN)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:BENJAMIN
Last Name:WALKER-RICHARDS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 NW APPLE BLOSSOM LOOP
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8953
Mailing Address - Country:US
Mailing Address - Phone:360-621-7517
Mailing Address - Fax:
Practice Address - Street 1:770 NW APPLE BLOSSOM LOOP
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8953
Practice Address - Country:US
Practice Address - Phone:360-621-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60330097163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse