Provider Demographics
NPI:1407334451
Name:WALTON, DOROTHY ELLEN (RN)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ELLEN
Last Name:WALTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 AMERICA AVE NW STE 130
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3848
Mailing Address - Country:US
Mailing Address - Phone:218-333-8155
Mailing Address - Fax:218-333-8140
Practice Address - Street 1:616 AMERICA AVE NW STE 130
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3848
Practice Address - Country:US
Practice Address - Phone:218-333-8155
Practice Address - Fax:218-333-8140
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1327290163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse