Individual
NICHOLAS JOSEPH WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
Mailing address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02007449A
IN
Other
Enumeration date
03/25/2020
Last updated
08/16/2023
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