Provider Demographics
NPI:1679289003
Name:WALPOLE, KATHRYN GRETCHEN
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRETCHEN
Last Name:WALPOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 S CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-5349
Mailing Address - Country:US
Mailing Address - Phone:317-646-5336
Mailing Address - Fax:
Practice Address - Street 1:902 S CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5349
Practice Address - Country:US
Practice Address - Phone:317-646-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula