Healthcare Provider Details

I. General information

NPI: 1417343765
Provider Name (Legal Business Name): SARAH REBECCA WALTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 TRINITY ST STOP A
AUSTIN TX
78712-1766
US

IV. Provider business mailing address

1601 TRINITY ST STOP A
AUSTIN TX
78712-1766
US

V. Phone/Fax

Practice location:
  • Phone: 512-495-5300
  • Fax: 512-495-5680
Mailing address:
  • Phone: 512-495-5300
  • Fax: 512-495-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number793755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: