Individual
TENEA LATRICE WALKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2780 MAHIXON RD, MANQUIN, VA 23106-2318
(804) 246-8742
Mailing address
PO BOX 1012, AYLETT, VA 23009-1012
(804) 246-8742
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
A64201169
VA
347C00000X
Private Vehicle
A67201169
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
347C00000X-
—
VA
Enumeration date
05/21/2020
Last updated
05/21/2020
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