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General NPI Number Information
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NPI Number | 1902450695
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Entity Type | Individual
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Provider Name | ERICA WALTER WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/31/2019
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Last Update Date | 07/31/2019
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Provider Practice Location Address
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Address Line | 4590 CHILDRENS PL FL 4
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1020
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Country | US
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Telephone | 314-747-2775
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Fax | 314-273-0124
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Provider Business Mailing Address
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Address Line | 404 FALLING LEAF WAY
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City | MASCOUTAH
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State | IL
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Zip | 62258-2786
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Country | US
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Telephone | 618-317-6890
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 2019010059
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License Number State | MO
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