Healthcare Provider Details

I. General information

NPI: 1669548574
Provider Name (Legal Business Name): WALTON FRANCIS REDDISH CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 WOODBROOKE DRIVE
SALISBURY MD
21804
US

IV. Provider business mailing address

PO BOX 2415
SALISBURY MD
21802-2415
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-4154
  • Fax:
Mailing address:
  • Phone: 410-749-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR077177
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000518
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: