Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | C20008477 | DE |
N | 208000000X | Pediatrician | OS014105 | PA |
N | 208D00000X | General Practice Physician | OS014105 | PA |
NPI | 1013032770 |
---|---|
Provider Name | Stephanie G Walter |
First Address | Rockland, DE 19732-0191 |
Second Address | Wilmington, DE 19803-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 26/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0141542 | (05) | NJ |
102043734 | (05) | PA |
413365000 | (05) | MD |