Provider Demographics
NPI:1851317069
Name:MCDOWELL, WALTER WAYNE (CERTIFIED FAMILY NP)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:WAYNE
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:CERTIFIED FAMILY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 VIRGINIA ST E
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-2412
Mailing Address - Country:US
Mailing Address - Phone:304-388-2545
Mailing Address - Fax:304-388-2781
Practice Address - Street 1:800 PENNSYLVANIA AVE
Practice Address - Street 2:CAMC WOMENS AND CHILDRENS DIVISION FAMILY RESOURCE CTR
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-3351
Practice Address - Country:US
Practice Address - Phone:304-388-2545
Practice Address - Fax:304-388-2781
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39314363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVMCNP78271Medicare ID - Type Unspecified