Provider Demographics
NPI:1437781416
Name:WALTHERS, ANDREA MARIE DEFELICE (NP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE DEFELICE
Last Name:WALTHERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 V ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1476
Mailing Address - Country:US
Mailing Address - Phone:916-734-7211
Mailing Address - Fax:
Practice Address - Street 1:4010 V ST STE 1200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1476
Practice Address - Country:US
Practice Address - Phone:916-734-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012354363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner