Provider Demographics
NPI:1609607738
Name:WALKER, MIRANDA ELIZABETH
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:ELIZABETH
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 1:4183 BROGAN DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4955
Mailing Address - Country:US
Mailing Address - Phone:419-378-1841
Mailing Address - Fax:
Practice Address - Street 1:4183 BROGAN DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-4955
Practice Address - Country:US
Practice Address - Phone:419-378-1841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide