Provider Demographics
NPI:1326423815
Name:WALTER, LESLIE ANN (CNM)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANN
Last Name:WALTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1234
Mailing Address - Country:US
Mailing Address - Phone:207-798-3993
Mailing Address - Fax:207-799-3999
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1234
Practice Address - Country:US
Practice Address - Phone:207-798-3993
Practice Address - Fax:207-799-3999
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW235776367A00000X
ME152001367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife