Provider Demographics
NPI:1942681408
Name:WALTON, REBECCA A (RN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:WALTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WEBSTER ST
Mailing Address - Street 2:UNIT #4
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3834
Mailing Address - Country:US
Mailing Address - Phone:603-321-7672
Mailing Address - Fax:
Practice Address - Street 1:32 TOLMAN AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2237
Practice Address - Country:US
Practice Address - Phone:978-944-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260923163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse