Individual
TISHA LINN WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
7015C MANCHESTER BLVD, ALEXANDRIA, VA 22310-3420
(703) 971-6900
Mailing address
3914 CENTREVILLE RD STE 225, CHANTILLY, VA 20151-3045
(703) 956-6301
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024197661
VA
Other
Enumeration date
07/20/2020
Last updated
07/20/2020
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