Provider Demographics
NPI:1053018291
Name:WALTERS, CRISTEE S
Entity type:Individual
Prefix:
First Name:CRISTEE
Middle Name:S
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4146 MIDDLEHURST LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3430
Mailing Address - Country:US
Mailing Address - Phone:937-829-5922
Mailing Address - Fax:
Practice Address - Street 1:4146 MIDDLEHURST LN
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-3430
Practice Address - Country:US
Practice Address - Phone:937-829-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602477361022376K00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide