Provider Demographics
NPI:1124782941
Name:WALTER, CAITLIN SMITH (APRN)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:SMITH
Last Name:WALTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58655 284TH ST
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:IA
Mailing Address - Zip Code:51551-5219
Mailing Address - Country:US
Mailing Address - Phone:402-807-3406
Mailing Address - Fax:
Practice Address - Street 1:201 RIDGE ST STE 201
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4643
Practice Address - Country:US
Practice Address - Phone:712-322-5899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA165442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine