Individual
CAROLINE L WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
621 MEMORIAL DR STE 502, SOUTH BEND, IN 46601-1075
(574) 647-5875
(574) 647-5878
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1840
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10003018A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300047046
—
IN
Enumeration date
08/10/2020
Last updated
06/23/2025
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