Healthcare Provider Details

I. General information

NPI: 1902698046
Provider Name (Legal Business Name): WALTER AMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 COOPER HAWK LN
CROSS LANES WV
25313-1866
US

IV. Provider business mailing address

204 COOPER HAWK LN
CROSS LANES WV
25313-1866
US

V. Phone/Fax

Practice location:
  • Phone: 304-521-3480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: