Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | SP022873 | PA |
NPI | 1548856461 |
---|---|
Provider Name | Donald Walton |
First Address | Coatesville, PA 19320-6144 |
Second Address | Lancaster, PA 17602-2374 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2020 |
Last Update Date | 15/12/2020 |