Basic Information
| Provider Information | |||||||||
| NPI: | 1639268337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALTER | ||||||||
| FirstName: | BRENDA | ||||||||
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| Credential: | NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1930 ALCOA HWY | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653056650 | ||||||||
| FaxNumber: | 8653055857 | ||||||||
| Practice Location | |||||||||
| Address1: | 1930 ALCOA HWY | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379201500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653056650 | ||||||||
| FaxNumber: | 8653055857 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 11/07/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | 10603 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | 163W00000X | 86671 | TN | N | Nursing Service Providers | Registered Nurse |
No ID Information.