Provider Demographics
NPI:1740658640
Name:WALKER, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name: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 1:5405 3RD CT E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-5010
Mailing Address - Country:US
Mailing Address - Phone:205-765-4110
Mailing Address - Fax:205-764-9367
Practice Address - Street 1:800 22ND AVE
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-2142
Practice Address - Country:US
Practice Address - Phone:205-765-1312
Practice Address - Fax:205-764-9367
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care