Provider Demographics
NPI:1427232107
Name:WALTER, IRA M (MSN-ED, APRN, FNP)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:M
Last Name:WALTER
Suffix:
Gender:M
Credentials:MSN-ED, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PINE DR APT 102
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-7239
Mailing Address - Country:US
Mailing Address - Phone:845-665-9414
Mailing Address - Fax:
Practice Address - Street 1:600 PINE DR APT 102
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-7239
Practice Address - Country:US
Practice Address - Phone:845-665-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY602855163W00000X
FLRN9290651163WM0705X
FL11013625363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care