Provider Demographics
NPI:1770179343
Name:WALTERS, JULIANNE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JULIANNE
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3803 W CHESTER PIKE STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-2336
Mailing Address - Country:US
Mailing Address - Phone:484-337-1530
Mailing Address - Fax:484-337-1412
Practice Address - Street 1:3803 W CHESTER PIKE STE 160
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2336
Practice Address - Country:US
Practice Address - Phone:484-337-1530
Practice Address - Fax:484-337-1412
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022563363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health