Provider Demographics
NPI:1952346769
Name:WALKER-VAMOS, COLLEEN ELYSE (DO)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:ELYSE
Last Name:WALKER-VAMOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605 MAYPORT DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-6703
Mailing Address - Country:US
Mailing Address - Phone:702-469-9442
Mailing Address - Fax:
Practice Address - Street 1:595 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PIOCHE
Practice Address - State:NV
Practice Address - Zip Code:89043
Practice Address - Country:US
Practice Address - Phone:702-469-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVDO1955207R00000X
AZ005200207L00000X
PAOS014275208M00000X, 207L00000X
IN02002972207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI45169Medicare UPIN