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NPI Code Detail

MEDICARE: TONYA WALTERS LPN

MEDICARE: TONYA WALTERS LPN
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
1164W00000XLicensed Practical NurseLPN 124422OH
2171M00000XCase Manager/Care Coordinator

Other Identifiers

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

General Provider Information

NPI Number : 1861939522
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA WALTERS LPN
Provider Business Mailing Address
First Line : 445 E DUBLIN GRANVILLE RD
Second Line :
City : WORTHINGTON
State : OH
Zip : 43085-3192
Country : US
Telephone Number : 614-844-3800
Fax Number :
Provider Business Practice Location Address
First Line : 22 N 1ST ST
Second Line :
City : NEWARK
State : OH
Zip : 43055-5608
Country : US
Telephone Number : 614-844-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2017
Last Update Date : 05/27/2022

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