Provider Demographics
NPI:1588313373
Name:WALTERS, HEATHERS LEANN
Entity type:Individual
Prefix:
First Name:HEATHERS
Middle Name:LEANN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 TARIFF RD
Mailing Address - Street 2:
Mailing Address - City:LOONEYVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25259-9615
Mailing Address - Country:US
Mailing Address - Phone:304-377-7219
Mailing Address - Fax:
Practice Address - Street 1:3225 TARIFF RD
Practice Address - Street 2:
Practice Address - City:LOONEYVILLE
Practice Address - State:WV
Practice Address - Zip Code:25259-9615
Practice Address - Country:US
Practice Address - Phone:304-377-7219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant