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General NPI Number Information
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NPI Number | 1669941027
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Entity Type | Individual
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Provider Name | WALETTRA CHARMESE ENOCH NP
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Gender | Female
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Dates
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Enumeration Date | 11/15/2018
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 156 WILLIAM ST RM 303
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City | NEW YORK
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State | NY
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Zip | 10038-5307
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Country | US
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Telephone | 888-803-3370
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Fax |
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Provider Business Mailing Address
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Address Line | 7507 SOCIETY DR
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City | CLAYMONT
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State | DE
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Zip | 19703-1775
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Country | US
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Telephone | 215-397-7104
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | LP0010478
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 310872
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | SP019360
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License Number State | PA
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