Individual
BRANDDY WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3617 S PACIFIC HWY, MEDFORD, OR 97501-8957
(541) 535-6239
(541) 842-2212
Mailing address
931 CHEVY WAY, MEDFORD, OR 97504-4127
(541) 690-3555
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201505008RN
OR
363LF0000X
Family Nurse Practitioner
Primary
202212643NP-PP
OR
Other
Enumeration date
06/02/2016
Last updated
08/19/2022
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