Provider Demographics
NPI:1427764182
Name:WALTERS, JESSIE W (RN)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:W
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7241 W ROSE GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9634
Mailing Address - Country:US
Mailing Address - Phone:623-376-4810
Mailing Address - Fax:623-376-4880
Practice Address - Street 1:7241 W ROSE GARDEN LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-9634
Practice Address - Country:US
Practice Address - Phone:623-376-4810
Practice Address - Fax:623-376-4880
Is Sole Proprietor?:No
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN157591163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool