Healthcare Provider Details

I. General information

NPI: 1629073317
Provider Name (Legal Business Name): JANE M WALTER C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SPRUCE ST
KULPMONT PA
17834-1234
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-4093
US

V. Phone/Fax

Practice location:
  • Phone: 570-373-2100
  • Fax: 570-373-2101
Mailing address:
  • Phone: 570-271-6144
  • Fax: 570-271-6578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberVP006158B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: