Individual
MR. NICHOLAS RYAN WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7600 W COLLEGE DR, PALOS HEIGHTS, IL 60463-1001
(708) 361-0600
Mailing address
510 W ELLE ST, ROMEOVILLE, IL 60446-5295
(630) 723-8699
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
096-002105
IL
363A00000X
Physician Assistant
Primary
085.004177
IL
Other
Enumeration date
04/13/2006
Last updated
02/20/2015
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