Provider Demographics
NPI:1912339433
Name:WALTER, JENNIFER ELIZABETH (CNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:WALTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELIZABETH
Other - Last Name:HAGUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:1800 MENDON RD STE E-166
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-4391
Mailing Address - Country:US
Mailing Address - Phone:401-680-0393
Mailing Address - Fax:401-344-4430
Practice Address - Street 1:2374 DIAMOND HILL RD UNIT 1
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-4745
Practice Address - Country:US
Practice Address - Phone:401-680-0393
Practice Address - Fax:401-680-0393
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN213241-3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health