Provider Demographics
NPI:1710901509
Name:WALTER, MARY ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
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 1:515 ABBOTT RD
Mailing Address - Street 2:STE 302
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-1700
Mailing Address - Country:US
Mailing Address - Phone:716-828-3520
Mailing Address - Fax:716-828-3550
Practice Address - Street 1:515 ABBOTT RD
Practice Address - Street 2:STE 302
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-1700
Practice Address - Country:US
Practice Address - Phone:716-828-3520
Practice Address - Fax:716-828-3550
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560180003OtherBLUE CROSS OF WNY
NY051017000049OtherFIDELIS
NY9512126OtherINDEPENDENT HEALTH
NY00026546805OtherUNIVERA
NY00026546806OtherUNIVERA
NY000560180004OtherBLUE CROSS OF WNY
NYP00287556OtherRAILROAD MEDICARE
NY000560180004OtherBLUE CROSS OF WNY
NY051017000049OtherFIDELIS
NY00026546806OtherUNIVERA