Provider Demographics
NPI:1215032354
Name:WALTS, INA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:INA
Middle Name:MARIE
Last Name:WALTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9285 SIERRA COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5919
Mailing Address - Country:US
Mailing Address - Phone:916-784-3376
Mailing Address - Fax:
Practice Address - Street 1:9285 SIERRA COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5919
Practice Address - Country:US
Practice Address - Phone:916-784-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17683363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant