Provider Demographics
NPI:1255585386
Name:WALZ, DENISE MARIE (RN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:WALZ
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 1:611 ROLLING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-8734
Mailing Address - Country:US
Mailing Address - Phone:919-304-0724
Mailing Address - Fax:
Practice Address - Street 1:611 ROLLING MEADOW DR
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-8734
Practice Address - Country:US
Practice Address - Phone:919-304-0724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC226388163W00000X
MI4704260391163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse