| NPI | 1790064343 |
|---|---|
| Former Name | CARRIE L WALTERS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: SC 1667) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: SC Applied For) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2016-08-15 |