Provider Demographics
NPI:1780985945
Name:WALTERS, EVADNIE
Entity type:Individual
Prefix:MISS
First Name:EVADNIE
Middle Name:
Last Name:WALTERS
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:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:CLARCONA
Mailing Address - State:FL
Mailing Address - Zip Code:32710-0831
Mailing Address - Country:US
Mailing Address - Phone:407-844-0370
Mailing Address - Fax:407-574-7350
Practice Address - Street 1:750 S. ORANGE BLOSSOM TRAIL
Practice Address - Street 2:SUITE 134
Practice Address - City:ORLANOD
Practice Address - State:FL
Practice Address - Zip Code:32805
Practice Address - Country:US
Practice Address - Phone:407-844-0370
Practice Address - Fax:407-574-7350
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator