Healthcare Provider Details

I. General information

NPI: 1184791386
Provider Name (Legal Business Name): ELIZABETH WALTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 STEMMERS RUN RD STE F
BALTIMORE MD
21221-3361
US

IV. Provider business mailing address

5 RANDY FROST CT
BALTIMORE MD
21220-3713
US

V. Phone/Fax

Practice location:
  • Phone: 410-780-3640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR107924
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: