Provider Demographics
NPI:1801115753
Name:WALTER, ALEXIS B (NP)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:B
Last Name:WALTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2208 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5809
Mailing Address - Country:US
Mailing Address - Phone:315-798-8737
Mailing Address - Fax:315-733-9250
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 345
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-894-2224
Practice Address - Fax:703-894-2224
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily