Provider Demographics
NPI:1447227665
Name:WALKER, RITA C (FNP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:C
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1648
Mailing Address - Country:US
Mailing Address - Phone:608-375-4144
Mailing Address - Fax:608-375-5629
Practice Address - Street 1:208 PARKER ST
Practice Address - Street 2:
Practice Address - City:BOSCOBEL
Practice Address - State:WI
Practice Address - Zip Code:53805-1648
Practice Address - Country:US
Practice Address - Phone:608-375-4144
Practice Address - Fax:608-375-5629
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI147014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43819000Medicaid
WI24051Medicare ID - Type UnspecifiedMEDICARE ID#
WI43819000Medicaid