Individual
CHADBOURNE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP
Contact information
Practice address
2105 E ENTERPRISE AVE, STE 111, APPLETON, WI 54913-7862
(920) 731-6611
(920) 731-6732
Mailing address
2105 E ENTERPRISE AVE, STE 111, APPLETON, WI 54913-7862
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10333-33
WI
363LF0000X
Family Nurse Practitioner
10333
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10333-33
WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES (ADVANCED PRACTICE NURS
WI
01
—
187532-30
WISCONSIN DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES (REGISTERED NURSE)
WI
Enumeration date
12/19/2020
Last updated
09/14/2021
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