Individual
RENEE ELLEN WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
2367 B CYPRESS CIRCLE, CONWAY, SC 29526-8921
(843) 349-1001
(843) 349-1008
Mailing address
300 SINGLETON RIDGE RD, ATTN PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
27384
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26NJ01393800
APN LICENSE
NJ
01
—
26NR11450300
RN LICENSE
NJ
05
—
NP9477
—
SC
Enumeration date
11/10/2022
Last updated
07/31/2023
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