Provider Demographics
NPI:1497431035
Name:WALLER, CATRINA ELIZABETH
Entity Type:Individual
Prefix:
First Name:CATRINA
Middle Name:ELIZABETH
Last Name:WALLER
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 1:1423 CAPITOL TRL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5709
Mailing Address - Country:US
Mailing Address - Phone:302-577-0906
Mailing Address - Fax:
Practice Address - Street 1:1423 CAPITOL TRL
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-5709
Practice Address - Country:US
Practice Address - Phone:302-577-0906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL2-0024178164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse