| NPI | 1730815960 |
|---|---|
| Former Name | MELLISSA SUE IVY WALTER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP61216242) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA 61216242) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WA AP61216242) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61216242) | |
| Enumeration Date | 2022-07-29 |
| Last Update Date | 2024-05-02 |