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Individual
PHILIP JAMES WALTERS
Active
Individual
PHILIP JAMES WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
SP012411
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1615266
GATEWAY MEDICARE ASSURED
PA
01
—
2753065
HIGHMARK BLUE SHIELD FREEDOM BLUE
PA
Enumeration date
10/08/2012
Last updated
05/06/2021
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