Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 500805 | TX |
NPI | 1013174887 |
---|---|
Provider Name | Mrs. Alta Faye Walter |
First Address | Gatesville, TX 76528-3867 |
Second Address | Gatesville, TX 76528-3867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2008 |
Last Update Date | 20/05/2008 |