Healthcare Provider Details

I. General information

NPI: 1588719181
Provider Name (Legal Business Name): CATHERINE ANNA WALTER RN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PLZ
DAYTON OH
45404-1898
US

IV. Provider business mailing address

2803 WAGON WHEEL WAY
TROY OH
45373-8942
US

V. Phone/Fax

Practice location:
  • Phone: 937-641-3040
  • Fax:
Mailing address:
  • Phone: 937-335-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN211261 NP03694
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: