Provider Demographics
NPI:1689151367
Name:WALTER, MATTHEW JAMES (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAMES
Last Name:WALTER
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 COUTANT RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10919-3266
Mailing Address - Country:US
Mailing Address - Phone:845-857-7352
Mailing Address - Fax:
Practice Address - Street 1:146 COUTANT RD
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:NY
Practice Address - Zip Code:10919-3266
Practice Address - Country:US
Practice Address - Phone:845-857-7352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630590163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse