Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 209009739 | IL |
NPI | 1053665711 |
---|---|
Provider Name | Donna R Walters |
First Address | Marion, IL 62959-6477 |
Second Address | Marion, IL 62959-6477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2012 |
Last Update Date | 24/04/2018 |