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General NPI Number Information
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NPI Number | 1407897168
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Entity Type | Individual
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Provider Name | LEAH M WALTERS RDLD/CDE
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Gender | Female
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 705 PLEASANT AVE S
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City | PARK RAPIDS
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State | MN
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Zip | 56470-1440
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Country | US
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Telephone | 218-732-2800
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Fax | 218-732-2874
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Provider Business Mailing Address
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Address Line | PO BOX 6001
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City | FARGO
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State | ND
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Zip | 58108-6001
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Country | US
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Telephone | 218-732-2800
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Fax | 218-732-2874
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 1507
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 1507
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License Number State | MN
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