Provider Demographics
NPI:1780014027
Name:WALKER-AVOINE, EVADNEY E
Entity type:Individual
Prefix:
First Name:EVADNEY
Middle Name:E
Last Name:WALKER-AVOINE
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 1:201 22ND STREET CT NE
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-1756
Mailing Address - Country:US
Mailing Address - Phone:941-224-4064
Mailing Address - Fax:941-254-2052
Practice Address - Street 1:201 22ND STREET CT NE
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1756
Practice Address - Country:US
Practice Address - Phone:941-224-4064
Practice Address - Fax:941-254-2052
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE6906621311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009317600Medicaid