Provider Demographics
NPI:1831821545
Name:WALTERS, JAN MARIE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:MARIE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163347 RIVER HILLS RD
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-8860
Mailing Address - Country:US
Mailing Address - Phone:715-551-9815
Mailing Address - Fax:
Practice Address - Street 1:163347 RIVER HILLS RD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-8860
Practice Address - Country:US
Practice Address - Phone:715-551-9815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI114051-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse