Provider Demographics
NPI:1851940464
Name:WALTHER, EMILY ROSE (FNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:WALTHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11286 MEADOW GLEN WAY E
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-7009
Mailing Address - Country:US
Mailing Address - Phone:760-975-1987
Mailing Address - Fax:
Practice Address - Street 1:9665 CHESAPEAKE DR STE 350
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1352
Practice Address - Country:US
Practice Address - Phone:760-975-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-06
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA728145163W00000X
CA95004124363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse