Provider Demographics
NPI:1427353929
Name:WALTERS, EMILY JEANNE (LPN)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:JEANNE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 MARCIA DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-1859
Mailing Address - Country:US
Mailing Address - Phone:513-907-9222
Mailing Address - Fax:
Practice Address - Street 1:973 MARCIA DR
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-1859
Practice Address - Country:US
Practice Address - Phone:513-907-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.126896-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse