Provider Demographics
NPI:1356717086
Name:WALTER, CARLA (PA-C)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:21800 MARKET PL NW STE 104
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6667
Mailing Address - Country:US
Mailing Address - Phone:833-411-5469
Mailing Address - Fax:855-459-3020
Practice Address - Street 1:21800 MARKET PL STE 104
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6667
Practice Address - Country:US
Practice Address - Phone:833-411-5469
Practice Address - Fax:855-459-3020
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA60604811363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8946666Medicare PIN