Provider Demographics
NPI:1538504022
Name:WALTMAN, CARRIE A (NP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:A
Last Name:WALTMAN
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 1:11713 BURRAY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5155
Mailing Address - Country:US
Mailing Address - Phone:804-402-8633
Mailing Address - Fax:804-777-9668
Practice Address - Street 1:11713 BURRAY RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-5155
Practice Address - Country:US
Practice Address - Phone:804-402-8633
Practice Address - Fax:804-777-9668
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164129363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily