Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D14097 | MN |
NPI | 1124540828 |
---|---|
Provider Name | Dr. Erica Jane Walters |
First Address | Mankato, MN 56001-5422 |
Second Address | Mankato, MN 56001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2017 |
Last Update Date | 20/08/2018 |