Provider Demographics
NPI:1265060495
Name:UNDERWOOD, WALTER LEE (RN)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:LEE
Last Name:UNDERWOOD
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 1:600 S 1ST ST APT 338
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-1108
Mailing Address - Country:US
Mailing Address - Phone:956-459-1621
Mailing Address - Fax:
Practice Address - Street 1:600 S 1ST ST APT 338
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1108
Practice Address - Country:US
Practice Address - Phone:956-459-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711343163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse