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General NPI Number Information
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NPI Number | 1235740689
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Entity Type | Individual
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Provider Name | CAROLINE L WALTERS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/10/2020
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 621 MEMORIAL DR STE 502
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City | SOUTH BEND
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State | IN
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Zip | 46601-1075
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Country | US
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Telephone | 574-647-5875
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Fax | 574-647-5878
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR STE 100
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City | GRANGER
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State | IN
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Zip | 46530-1380
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Country | US
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Telephone | 574-647-1840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10003018A
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License Number State | IN
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