Healthcare Provider Details

I. General information

NPI: 1427266337
Provider Name (Legal Business Name): JOHN F WALTERS MS, MDIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 75
NEW ALBANY PA
18833-9730
US

IV. Provider business mailing address

RR 1 BOX 75
NEW ALBANY PA
18833-9730
US

V. Phone/Fax

Practice location:
  • Phone: 570-363-2808
  • Fax: 570-363-2648
Mailing address:
  • Phone: 570-363-2808
  • Fax: 570-363-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number000821
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: