Individual
WALTER A. WITHERSPOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4800
Mailing address
716 WRIGHT LN, MARSHALL, MI 49068-9612
(772) 269-1488
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
ARNP9198797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G3573
BCBS
FL
Enumeration date
03/06/2006
Last updated
07/08/2007
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