Provider Demographics
NPI:1689730178
Name:WALTMAN, DEANNETTE JEAN (RN)
Entity Type:Individual
Prefix:
First Name:DEANNETTE
Middle Name:JEAN
Last Name:WALTMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATTN CREDENTIALS OFFICE
Mailing Address - Street 2:CMR 442
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09042
Mailing Address - Country:DE
Mailing Address - Phone:49622-117-2274
Mailing Address - Fax:49622-117-2941
Practice Address - Street 1:STUTTGART HEALTH CLINIC
Practice Address - Street 2:PATCH BARRACKS UNIT 30401
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09107
Practice Address - Country:DE
Practice Address - Phone:49711-680-8610
Practice Address - Fax:49711-680-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN537091163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN537091OtherNURSING LICENSE