Provider Demographics
NPI:1134213390
Name:WALTERS-OLARU, DEBRA (APN)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:WALTERS-OLARU
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:WALTERS-OLARU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:20 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:MILMAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08340-2016
Mailing Address - Country:US
Mailing Address - Phone:856-466-2749
Mailing Address - Fax:
Practice Address - Street 1:801 BOARDWALK
Practice Address - Street 2:SHOWBOAT WELLNESS CENTER
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-7509
Practice Address - Country:US
Practice Address - Phone:609-343-4003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00017000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8886300Medicaid
Q00484Medicare UPIN
074114Medicare ID - Type Unspecified
NJ074114SBVMedicare PIN