Provider Demographics
NPI:1588719181
Name:WALTER, CATHERINE ANNA (RN, NNP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNA
Last Name:WALTER
Suffix:
Gender:F
Credentials:RN, NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 WAGON WHEEL WAY
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-8942
Mailing Address - Country:US
Mailing Address - Phone:937-335-9792
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PLZ
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1898
Practice Address - Country:US
Practice Address - Phone:937-641-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN211261 NP03694363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care