MEDICARE: REBECCA WALTERS NP

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	363LF0000X	Family Nurse Practitioner	749450	TX

General Provider Information

NPI Number	:	1821306747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA WALTERS NP

Provider Business Mailing Address
First Line	:	827 MAGNOLIA BLVD
Second Line	:	SUITE 6
City	:	MAGNOLIA
State	:	TX
Zip	:	77355-8602
Country	:	US
Telephone Number	:	281-356-2900
Fax Number	:	281-356-5830

Provider Business Practice Location Address
First Line	:	827 MAGNOLIA BLVD
Second Line	:	SUITE 6
City	:	MAGNOLIA
State	:	TX
Zip	:	77355-8602
Country	:	US
Telephone Number	:	281-356-2900
Fax Number	:	281-356-5830

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

Provider Enumeration Date	:	09/14/2010
Last Update Date	:	09/14/2010

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