Provider Demographics
NPI:1528501061
Name:WALTON, STEVEN BLAKE (CNP)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:BLAKE
Last Name:WALTON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:S BLAKE
Other - Middle Name:
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:150 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1335
Mailing Address - Country:US
Mailing Address - Phone:567-232-0193
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019418363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health