Provider Demographics
NPI:1831522630
Name:JEFFERSON-WALKER, MARIA (APN)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:JEFFERSON-WALKER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11834 S OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-4728
Mailing Address - Country:US
Mailing Address - Phone:773-680-7296
Mailing Address - Fax:
Practice Address - Street 1:10540 S WESTERN AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2541
Practice Address - Country:US
Practice Address - Phone:773-985-5734
Practice Address - Fax:773-941-5131
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily