Provider Demographics
NPI:1912970054
Name:WALKER, MARIE J (CRNA)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:J
Last Name:WALKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 17978
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-7978
Mailing Address - Country:US
Mailing Address - Phone:804-288-4453
Mailing Address - Fax:804-288-1621
Practice Address - Street 1:7640 E PARHAM ROAD
Practice Address - Street 2:PARHAM SURGERY CENTER
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294
Practice Address - Country:US
Practice Address - Phone:904-591-2200
Practice Address - Fax:804-591-2236
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024037126367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010316511Medicaid
VA010332W82Medicare PIN
TNP00334673Medicare PIN