Provider Demographics
NPI:1922680180
Name:WALTHER, LAUREL (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:
Last Name:WALTHER
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BRYCE BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-5811
Mailing Address - Country:US
Mailing Address - Phone:919-260-2068
Mailing Address - Fax:
Practice Address - Street 1:114 BRYCE BRANCH CIR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-5811
Practice Address - Country:US
Practice Address - Phone:919-260-2068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date: