Individual
MRS. COLLEEN SUE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
4570 ROUTE 60, GERRY, NY 14740
(716) 985-4612
Mailing address
232 MAIN ST, RANDOLPH, NY 14772-1221
(716) 378-2926
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
F335013-1
NY
Other
Enumeration date
01/25/2007
Last updated
12/22/2009
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