Provider Demographics
NPI:1780101345
Name:WALKER, VIRGINIA SUE (LPN)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SUE
Last Name:WALKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:SUE
Other - Last Name:AUGUSTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4201 E KNOX RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-4701
Mailing Address - Country:US
Mailing Address - Phone:480-388-8911
Mailing Address - Fax:480-388-8998
Practice Address - Street 1:4201 E KNOX RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4701
Practice Address - Country:US
Practice Address - Phone:480-388-8911
Practice Address - Fax:480-388-8998
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPO44451164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse