Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 32875 | CO |
NPI | 1003917113 |
---|---|
Provider Name | Lynda Walters |
First Address | Mesa, CO 81643-0297 |
Second Address | Collbran, CO 81624-9502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 26/01/2010 |