Individual
ANDREW WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3815 HARRISON AVE, ROCKFORD, IL 61108-7631
(815) 391-1000
Mailing address
3815 HARRISON AVE, ROCKFORD, IL 61108-7631
(815) 391-1000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041417411
IL
Other
Enumeration date
01/22/2020
Last updated
01/22/2020
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