Healthcare Provider Details

I. General information

NPI: 1801115753
Provider Name (Legal Business Name): ALEXIS B WALTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N GEORGE MASON DR SUITE 345
ARLINGTON VA
22205-3683
US

IV. Provider business mailing address

2208 GENESEE ST
UTICA NY
13502-5809
US

V. Phone/Fax

Practice location:
  • Phone: 703-894-2224
  • Fax: 703-894-2224
Mailing address:
  • Phone: 315-798-8737
  • Fax: 315-733-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168789
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: