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General NPI Number Information
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NPI Number | 1619595907
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Entity Type | Individual
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Provider Name | DONTA TAVON WALTON AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 8114 SANDPIPER CIR STE 207
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City | NOTTINGHAM
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State | MD
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Zip | 21236-5902
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Country | US
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Telephone | 443-600-8178
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Fax | 833-973-4725
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Provider Business Mailing Address
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Address Line | 8114 SANDPIPER CIR STE 207
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City | NOTTINGHAM
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State | MD
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Zip | 21236-5902
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Country | US
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Telephone | 443-854-1553
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Fax | 833-973-4725
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R211890
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License Number State | MD
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