Provider Demographics
NPI:1700643632
Name:WALTER, ALLISON PAIGE
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:PAIGE
Last Name:WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FIREMANS LODGE RD SW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-9115
Mailing Address - Country:US
Mailing Address - Phone:320-808-5959
Mailing Address - Fax:
Practice Address - Street 1:1400 FIREMANS LODGE RD SW
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-9115
Practice Address - Country:US
Practice Address - Phone:320-808-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant