Healthcare Provider Details

I. General information

NPI: 1851569131
Provider Name (Legal Business Name): PATTI SUE WALTERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATTI SUE GROOVER FNP

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 E NATIONAL AVE STE 90A
BRAZIL IN
47834-2746
US

IV. Provider business mailing address

1214 E NATIONAL AVE STE 90A
BRAZIL IN
47834-2746
US

V. Phone/Fax

Practice location:
  • Phone: 812-442-2900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002598A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71002598A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: