Provider Demographics
NPI:1558613125
Name:WALTERS, PHILIP JAMES (CRNP)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JAMES
Last Name:WALTERS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 BRUNSWICK DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8350
Mailing Address - Country:US
Mailing Address - Phone:717-637-0470
Mailing Address - Fax:717-637-4987
Practice Address - Street 1:2201 BRUNSWICK DR STE 1200
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8350
Practice Address - Country:US
Practice Address - Phone:717-637-0470
Practice Address - Fax:717-637-4987
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1615266OtherGATEWAY MEDICARE ASSURED
PA2753065OtherHIGHMARK BLUE SHIELD FREEDOM BLUE
PA1615266OtherGATEWAY MEDICARE ASSURED
PA262621FLTMedicare PIN