Provider Demographics
NPI:1881628154
Name:WALKER, NANCY J (MD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2760 CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3359
Mailing Address - Country:US
Mailing Address - Phone:610-375-4251
Mailing Address - Fax:610-375-6210
Practice Address - Street 1:2760 CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3359
Practice Address - Country:US
Practice Address - Phone:610-375-4251
Practice Address - Fax:610-375-6210
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0066984207RR0500X
PAMD423679174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2349134000OtherKEYSTONE HEALTH PLANS
PA2349134000OtherINDEPENDENCE BLUE CROSS
PAMD423679OtherMEDICAL LICENSE
PA1881628154OtherNPI
PA1881628154OtherNPI
PA2349134000OtherINDEPENDENCE BLUE CROSS
PAI04009Medicare UPIN