Individual
STEPHANIE WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
824 S LEROY ST, FENTON, MI 48430-2911
(813) 928-1151
Mailing address
824 S LEROY ST, FENTON, MI 48430-2911
(813) 928-1151
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703113601
MI
Other
Enumeration date
02/09/2015
Last updated
02/09/2015
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