Provider Demographics
NPI:1790522464
Name:WALTER, EMILY (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 E EAGLE DR UNIT 20730
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85277-3031
Mailing Address - Country:US
Mailing Address - Phone:480-706-9430
Mailing Address - Fax:
Practice Address - Street 1:7900 E PRINCESS DR APT 1179
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5861
Practice Address - Country:US
Practice Address - Phone:206-550-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty