Provider Demographics
NPI:1114019247
Name:WALTERS, VERONICA JEANNE (APRN BC)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:JEANNE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W MARINE VIEW DR # S313
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1661
Mailing Address - Country:US
Mailing Address - Phone:419-575-0509
Mailing Address - Fax:
Practice Address - Street 1:4225 HOYT AVE STE D
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2351
Practice Address - Country:US
Practice Address - Phone:425-317-8025
Practice Address - Fax:425-317-9516
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18229363LF0000X
WAAP61001571363LF0000X
NJ26NJ01470900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2753337Medicaid
OHNP23149Medicare PIN
OHNP37981Medicare PIN