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General NPI Number Information
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NPI Number | 1417003518
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Entity Type | Individual
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Provider Name | COLLEEN SUE WALTERS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 4570 ROUTE 60
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City | GERRY
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State | NY
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Zip | 14740
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Country | US
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Telephone | 716-985-4612
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Fax |
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Provider Business Mailing Address
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Address Line | 232 MAIN ST
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City | RANDOLPH
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State | NY
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Zip | 14772-1221
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Country | US
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Telephone | 716-378-2926
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F335013-1
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License Number State | NY
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