Provider Demographics
NPI:1841834090
Name:CARRIE A WALTMAN FNP PLLC
Entity type:Organization
Organization Name:CARRIE A WALTMAN FNP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:804-402-8633
Mailing Address - Street 1:11713 BURRAY RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23838-5155
Mailing Address - Country:US
Mailing Address - Phone:804-402-8633
Mailing Address - Fax:804-777-9668
Practice Address - Street 1:11713 BURRAY RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23838-5155
Practice Address - Country:US
Practice Address - Phone:804-402-8633
Practice Address - Fax:804-777-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty