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General NPI Number Information
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NPI Number | 1457987497
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Entity Type | Individual
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Provider Name | WALTER DONICA
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Gender | Male
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Dates
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Enumeration Date | 03/22/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 2184 VICTORY PKWY APT 2
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City | CINCINNATI
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State | OH
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Zip | 45206-2813
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Country | US
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Telephone | 513-646-1691
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Fax |
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Provider Business Mailing Address
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Address Line | 950 CHARLES ST
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City | LOUISVILLE
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State | KY
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Zip | 40204-2469
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Country | US
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Telephone | 513-646-1691
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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