Provider Demographics
NPI:1326538075
Name:WALTHER, LAURA RUTH (APN)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:RUTH
Last Name:WALTHER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 ONEIDA DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-4812
Mailing Address - Country:US
Mailing Address - Phone:847-708-6291
Mailing Address - Fax:
Practice Address - Street 1:800 E WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4717
Practice Address - Country:US
Practice Address - Phone:847-995-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily