Provider Demographics
NPI:1538821244
Name:WALKER, DENISE VANITA
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:VANITA
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 1:3140 LEEDS ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3817
Mailing Address - Country:US
Mailing Address - Phone:443-802-1117
Mailing Address - Fax:443-708-2991
Practice Address - Street 1:3140 LEEDS ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3817
Practice Address - Country:US
Practice Address - Phone:443-802-1117
Practice Address - Fax:443-708-2991
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-10
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR096747163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD30AL3971Medicaid