Provider Demographics
NPI:1255758991
Name:WALTERS, CRAIG ALLAN (RN)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ALLAN
Last Name:WALTERS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 FOREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3323
Mailing Address - Country:US
Mailing Address - Phone:330-306-8507
Mailing Address - Fax:
Practice Address - Street 1:436 FOREST HILL DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-3323
Practice Address - Country:US
Practice Address - Phone:330-306-8507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN317979163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse