Healthcare Provider Details

I. General information

NPI: 1801675483
Provider Name (Legal Business Name): DONNA WALTER BSN, MS, CARN, FNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2023
Last Update Date: 09/25/2023
Certification Date: 09/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W LANCASTER AVE
DEVON PA
19333-1560
US

IV. Provider business mailing address

3701 DEVONSHIRE PL
BENSALEM PA
19020-1440
US

V. Phone/Fax

Practice location:
  • Phone: 484-551-3366
  • Fax:
Mailing address:
  • Phone: 267-574-4116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN355467L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: