Individual
CLOVA WALTERS
Active
Individual
CLOVA WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD040380-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001175208
—
PA
01
—
596189
GATEWAY 65 COMPLETE
PA
01
—
E45224
AMERIHEALTH 65 COMPLETE
PA
Enumeration date
02/08/2007
Last updated
12/14/2020
Update your record
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