Individual
STEPHANIE M WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1020 WEST BROADWAY, UMP BROADWAY FAMILY MEDICINE, MINNEAPOLIS, MN 55411
(612) 302-8200
Mailing address
420 DELAWARE STREET SE, MMC 292 UNIVERSITY OF MINNESOTA PHYSICIANS, MINNEAPOLIS, MN 55455
(612) 302-8200
(612) 302-8275
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
46898
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
608R5WA
BLUE CROSS BLUE SHIELD
MN
01
—
611210
FAIRVIEW
—
01
—
66-08077
MEDICA HEALTH PLANS
MN
Enumeration date
09/20/2006
Last updated
07/08/2007
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