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General NPI Number Information
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NPI Number | 1912339433
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Entity Type | Individual
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Provider Name | JENNIFER ELIZABETH WALTER CNP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2374 DIAMOND HILL RD UNIT 1
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City | CUMBERLAND
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State | RI
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Zip | 02864-4745
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Country | US
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Telephone | 401-680-0393
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Fax | 401-680-0393
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Provider Business Mailing Address
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Address Line | 1800 MENDON RD STE E-166
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City | CUMBERLAND
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State | RI
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Zip | 02864-4391
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Country | US
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Telephone | 401-680-0393
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Fax | 401-344-4430
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 213241-3
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License Number State | MN
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