Provider Demographics
NPI:1497730543
Name:WALTON, WILLIAM CHRISTIAN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHRISTIAN
Last Name:WALTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 FAIRHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-7506
Mailing Address - Country:US
Mailing Address - Phone:336-945-3397
Mailing Address - Fax:
Practice Address - Street 1:WFUBMC
Practice Address - Street 2:MEDICAL CENTER BOULEVARD/AMBULATORY ANESTHESIA
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-713-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC45120367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8050237Medicaid
NC100766OtherNURSING LICENSE CERTIFICA
NC8050237Medicaid
NCP00299502Medicare PIN