Provider Demographics
NPI:1437327855
Name:WALTON, CARINE LORENE
Entity Type:Individual
Prefix:MRS
First Name:CARINE
Middle Name:LORENE
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARINE
Other - Middle Name:LORENE
Other - Last Name:IMHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10652 LOGAN CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3336
Mailing Address - Country:US
Mailing Address - Phone:801-253-6468
Mailing Address - Fax:
Practice Address - Street 1:10652 LOGAN CANYON RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-3336
Practice Address - Country:US
Practice Address - Phone:801-253-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5972771-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse