Provider Demographics
NPI:1649095084
Name:WALTHER, LINDA (RN)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WALTHER
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 1:992 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-6985
Mailing Address - Country:US
Mailing Address - Phone:651-260-2072
Mailing Address - Fax:
Practice Address - Street 1:161 RONDO AVE STE 1001
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-2391
Practice Address - Country:US
Practice Address - Phone:651-209-9993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN079015163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse