Provider Demographics
NPI:1407674195
Name:WALTERS, ANGELA D (FNP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:WALTERS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 N SECTION ST
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-7523
Mailing Address - Country:US
Mailing Address - Phone:812-268-4311
Mailing Address - Fax:
Practice Address - Street 1:2200 N SECTION ST STE A
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7523
Practice Address - Country:US
Practice Address - Phone:812-268-6292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015802A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice