Provider Demographics
NPI:1437933975
Name:WALTERS, BRAYLEE
Entity Type:Individual
Prefix:
First Name:BRAYLEE
Middle Name:
Last Name:WALTERS
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 1:153 SPLIT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:NEWFOUNDLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18445-2142
Mailing Address - Country:US
Mailing Address - Phone:609-917-4986
Mailing Address - Fax:
Practice Address - Street 1:153 SPLIT ROCK RD
Practice Address - Street 2:
Practice Address - City:NEWFOUNDLAND
Practice Address - State:PA
Practice Address - Zip Code:18445-2142
Practice Address - Country:US
Practice Address - Phone:609-917-4986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program