Individual
CHRISTAL WALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
488 MAPLE ST, BROOKLYN, NY 11225-4559
(570) 664-3739
Mailing address
488 MAPLE ST, BROOKLYN, NY 11225-4559
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
335015-01
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
862185375
OTHER
NY
Enumeration date
04/14/2022
Last updated
04/14/2022
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