Provider Demographics
NPI:1548875792
Name:WALKER-WHITE, THERESA E
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:E
Last Name:WALKER-WHITE
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 1:1902 BREWTON ST
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1842
Mailing Address - Country:US
Mailing Address - Phone:301-651-8719
Mailing Address - Fax:301-780-3895
Practice Address - Street 1:4934 FOOTE ST NE APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4754
Practice Address - Country:US
Practice Address - Phone:202-396-6530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant