Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 22DI02654600 | NJ |
N | 1223X0400X | Orthodontists | DS040238 | PA |
NPI | 1063806875 |
---|---|
Provider Name | Mrs. Alys Marie Walter |
First Address | Phillipsburg, NJ 08865-1384 |
Second Address | Phillipsburg, NJ 08865-1384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2015 |
Last Update Date | 06/02/2019 |