Individual
TIAWUANA V WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4575 MAIN ST, BRIDGEPORT, CT 06606-1836
(203) 344-0025
Mailing address
4575 MAIN ST, BRIDGEPORT, CT 06606-1836
(203) 344-0025
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
30425
CT
Other
Enumeration date
06/02/2021
Last updated
06/02/2021
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