Individual
JORDYN WALTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
424 W STATE HIGHWAY 5, WACONIA, MN 55387-1723
(952) 442-4461
Mailing address
424 W STATE HIGHWAY 5, WACONIA, MN 55387-1723
(952) 442-4461
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
68084
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1881155729
—
MN
Enumeration date
03/25/2019
Last updated
09/16/2022
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