Provider Demographics
NPI:1598497323
Name:WALTER, CHARISTELLA (NP)
Entity Type:Individual
Prefix:MISS
First Name:CHARISTELLA
Middle Name:
Last Name:WALTER
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 1:2700 N MAIN ST STE 506
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-6637
Mailing Address - Country:US
Mailing Address - Phone:714-835-5477
Mailing Address - Fax:
Practice Address - Street 1:2700 N MAIN ST STE 506
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6637
Practice Address - Country:US
Practice Address - Phone:714-835-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020949363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner