Provider Demographics
NPI:1386912947
Name:WALTERS, BRIAN S (NP)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:WALTERS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PLAZA DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ROSTRAVER TWP
Mailing Address - State:PA
Mailing Address - Zip Code:15012-4019
Mailing Address - Country:US
Mailing Address - Phone:724-379-5802
Mailing Address - Fax:724-823-0286
Practice Address - Street 1:800 PLAZA DR STE 400
Practice Address - Street 2:
Practice Address - City:ROSTRAVER TWP
Practice Address - State:PA
Practice Address - Zip Code:15012-4019
Practice Address - Country:US
Practice Address - Phone:724-379-5802
Practice Address - Fax:724-823-0286
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily