Individual
MRS. ANGELA M WALTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
77 NELSON ST STE 120, AUBURN, NY 13021-1941
(315) 252-7559
(315) 253-8104
Mailing address
17 LANSING ST, AUBURN, NY 13021-1983
(315) 255-7576
(315) 702-8393
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
025821
NEW YORK STATE ED
NY
Enumeration date
03/29/2020
Last updated
05/03/2023
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