Provider Demographics
NPI:1033384433
Name:WALTER, NICOLE MAUREEN (RN, MPA, IBCLC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MAUREEN
Last Name:WALTER
Suffix:
Gender:F
Credentials:RN, MPA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18160 COTTONWOOD RD
Mailing Address - Street 2:368
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707-9317
Mailing Address - Country:US
Mailing Address - Phone:503-716-2161
Mailing Address - Fax:
Practice Address - Street 1:2500 NE NEFF RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6015
Practice Address - Country:US
Practice Address - Phone:541-706-2641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200141652RN163WC1500X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health