Provider Demographics
NPI:1467428433
Name:WALTER, TODD W (APRN, CRNA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:W
Last Name:WALTER
Suffix:
Gender:M
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17189 CO 27 BLVD
Mailing Address - Street 2:
Mailing Address - City:PINE ISLAND
Mailing Address - State:MN
Mailing Address - Zip Code:55963
Mailing Address - Country:US
Mailing Address - Phone:507-261-3391
Mailing Address - Fax:
Practice Address - Street 1:17189 CO 27 BLVD
Practice Address - Street 2:
Practice Address - City:PINE ISLAND
Practice Address - State:MN
Practice Address - Zip Code:55963
Practice Address - Country:US
Practice Address - Phone:507-356-8323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1141722163W00000X
MN58367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse