Healthcare Provider Details

I. General information

NPI: 1457264038
Provider Name (Legal Business Name): HALLE WALCUTT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E RIVER ST
ELYRIA OH
44035-5902
US

IV. Provider business mailing address

21468 OAKHURST LN
STRONGSVILLE OH
44149-4898
US

V. Phone/Fax

Practice location:
  • Phone: 440-329-7500
  • Fax:
Mailing address:
  • Phone: 440-591-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: