Provider Demographics
NPI:1063147809
Name:WALDEN FAMILY HEALTH CARE LLC
Entity type:Organization
Organization Name:WALDEN FAMILY HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:812-320-4416
Mailing Address - Street 1:3775 HYDEN RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-8004
Mailing Address - Country:US
Mailing Address - Phone:812-624-8292
Mailing Address - Fax:812-247-8297
Practice Address - Street 1:3775 HYDEN RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-8004
Practice Address - Country:US
Practice Address - Phone:812-624-8292
Practice Address - Fax:812-247-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty