Provider Demographics
NPI:1871191445
Name:WALTERS, ROBERTA J
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7775 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43056-9354
Mailing Address - Country:US
Mailing Address - Phone:740-403-9101
Mailing Address - Fax:
Practice Address - Street 1:7775 LAKE DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43056-9354
Practice Address - Country:US
Practice Address - Phone:740-403-9101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide