Provider Demographics
NPI:1740621333
Name:WALKER, THERESA LYNN (RN,MSAC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:WALKER
Suffix:
Gender:F
Credentials:RN,MSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 CANYON POINT CIR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7774
Mailing Address - Country:US
Mailing Address - Phone:303-263-3643
Mailing Address - Fax:
Practice Address - Street 1:607 10TH ST STE 204
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-5828
Practice Address - Country:US
Practice Address - Phone:303-263-3643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1863171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1863OtherACUPUNCTURE
CO96913OtherRN
CO1863OtherACUPUNCTURE