Provider Demographics
NPI:1558420406
Name:WALTER, RHODA JOAN (CRNA)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:JOAN
Last Name:WALTER
Suffix:
Gender:F
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:PO BOX 630326
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-0326
Mailing Address - Country:US
Mailing Address - Phone:443-332-4088
Mailing Address - Fax:410-793-0809
Practice Address - Street 1:3001 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1189
Practice Address - Country:US
Practice Address - Phone:443-332-4088
Practice Address - Fax:410-793-0809
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000399367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
S51958Medicare UPIN
MD000577P65Medicare PIN