MEDICARE: MRS. CHERYL DIANE WALTER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11-02726	KS
2	367500000X	Certified Registered Nurse Anesthetist	557734	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538166327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL DIANE WALTER CRNA

Provider Business Mailing Address
First Line	:	4121 E ENGLISH ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67218-1317
Country	:	US
Telephone Number	:	785-443-2423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 N MAIN ST
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67501-4405
Country	:	US
Telephone Number	:	620-662-3111
Fax Number	:	620-662-3122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	11/07/2019

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