Provider Demographics
NPI:1740736719
Name:WALTER, MEREDITH (APN)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4979 INDIANA AVE STE 312
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-3850
Mailing Address - Country:US
Mailing Address - Phone:312-337-4150
Mailing Address - Fax:312-337-4311
Practice Address - Street 1:4979 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-3847
Practice Address - Country:US
Practice Address - Phone:312-337-4150
Practice Address - Fax:312-337-4311
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000000000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily