Individual
WALETTRA CHARMESE ENOCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
156 WILLIAM ST RM 303, NEW YORK, NY 10038-5307
(888) 803-3370
Mailing address
7507 SOCIETY DR, CLAYMONT, DE 19703-1775
(215) 397-7104
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
310872
NY
363LP2300X
Primary Care Nurse Practitioner
LP0010478
DE
363LP2300X
Primary Care Nurse Practitioner
Primary
SP019360
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912199415
—
PA
Enumeration date
11/15/2018
Last updated
10/21/2024
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