Basic Information
| Provider Information | |||||||||
| NPI: | 1073097523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | WHNP-BC. RNC-OB | ||||||||
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| Mailing Information | |||||||||
| Address1: | 673 MEDICAL GROUP | ||||||||
| Address2: | 5955 ZEAMER AVENUE | ||||||||
| City: | JBER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075803205 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 673 MDG, 5955 ZEAMER AVENUE | ||||||||
| Address2: | JBER | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075803205 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2018 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0101X | 1647646 | CO | Y | Nursing Service Providers | Registered Nurse | Women's Health Care, Ambulatory |
No ID Information.