Provider Demographics
NPI:1114074804
Name:WALTON, STEPHANI RAE (RN, BSN, MS, CDE)
Entity type:Individual
Prefix:MS
First Name:STEPHANI
Middle Name:RAE
Last Name:WALTON
Suffix:
Gender:F
Credentials:RN, BSN, MS, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10130 BERRYESSA DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7123
Mailing Address - Country:US
Mailing Address - Phone:209-474-6588
Mailing Address - Fax:
Practice Address - Street 1:1777 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5130
Practice Address - Country:US
Practice Address - Phone:209-825-2423
Practice Address - Fax:209-825-2409
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336510163WC1600X, 163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator