Provider Demographics
NPI:1326555368
Name:WALTHER, JANE TERESA
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:TERESA
Last Name:WALTHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 37TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3404
Mailing Address - Country:US
Mailing Address - Phone:507-289-7408
Mailing Address - Fax:507-289-9036
Practice Address - Street 1:500 37TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3404
Practice Address - Country:US
Practice Address - Phone:507-289-7408
Practice Address - Fax:507-289-9036
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist