Provider Demographics
NPI:1023398195
Name:WALTER, JULIE (CNA/HHA RN STUDENT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:CNA/HHA RN STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 STATE ROUTE 224
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NY
Mailing Address - Zip Code:14805-9795
Mailing Address - Country:US
Mailing Address - Phone:607-279-9436
Mailing Address - Fax:
Practice Address - Street 1:5905 STATE ROUTE 224
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:NY
Practice Address - Zip Code:14805-9795
Practice Address - Country:US
Practice Address - Phone:607-279-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY343150780711E3747A0650X
NY00258477374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374U00000XNursing Service Related ProvidersHome Health Aide