Provider Demographics
NPI:1902653736
Name:WALTERS, SEAN
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:WALTERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 415 BOX 7536 APO, AE 09114-0076
Mailing Address - Street 2:
Mailing Address - City:GRAFENWOEHR
Mailing Address - State:BAVARIA
Mailing Address - Zip Code:09114
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 FA HHB HHB FIELD WAGJAA EAST CAMP GRAF AE 09114
Practice Address - Street 2:
Practice Address - City:GRAFENWOEHR
Practice Address - State:BAVARIA
Practice Address - Zip Code:09114
Practice Address - Country:DE
Practice Address - Phone:314-590-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant