Provider Demographics
NPI:1609257567
Name:WALKER, PATRINA
Entity type:Individual
Prefix:
First Name:PATRINA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CORVETTE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5284
Mailing Address - Country:US
Mailing Address - Phone:757-564-7999
Mailing Address - Fax:757-253-7551
Practice Address - Street 1:114 CORVETTE DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5284
Practice Address - Country:US
Practice Address - Phone:757-564-7999
Practice Address - Fax:757-253-7551
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT61926897172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver