Basic Information
| Provider Information | |||||||||
| NPI: | 1851379382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALTERS | ||||||||
| FirstName: | PEGGY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 EAST MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | GOSPORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474330009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128794222 | ||||||||
| FaxNumber: | 8128794834 | ||||||||
| Practice Location | |||||||||
| Address1: | 7 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | GOSPORT | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128794222 | ||||||||
| FaxNumber: | 8128794834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2006 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71002258A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.