Provider Demographics
NPI:1255481255
Name:WALTERS, PAULA (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-572-3500
Mailing Address - Fax:402-572-3505
Practice Address - Street 1:10109 MAPLE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-5554
Practice Address - Country:US
Practice Address - Phone:402-572-3500
Practice Address - Fax:402-572-3505
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22829207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine