Provider Demographics
NPI:1255800207
Name:WALTERS, ELIZABETH (CRNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 CLIVEDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-3502
Mailing Address - Country:US
Mailing Address - Phone:215-459-4953
Mailing Address - Fax:
Practice Address - Street 1:108 COWPATH RD STE 1
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1152
Practice Address - Country:US
Practice Address - Phone:215-855-1599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019405208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics