Individual
MR. HEADLEY JUNIOR RICKY WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BSN, RN
Contact information
Practice address
14400 SW 32ND ST, MIAMI, FL 33175-6545
(305) 220-9599
Mailing address
22018 SW 93RD PL, CUTLER BAY, FL 33190-1230
(786) 804-8696
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN9395952
FL
Other
Enumeration date
10/14/2019
Last updated
10/14/2019
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