Provider Demographics
NPI:1538166327
Name:WALTER, CHERYL DIANE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DIANE
Last Name:WALTER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 E ENGLISH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1317
Mailing Address - Country:US
Mailing Address - Phone:785-443-2423
Mailing Address - Fax:
Practice Address - Street 1:1125 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-4405
Practice Address - Country:US
Practice Address - Phone:620-662-3111
Practice Address - Fax:620-662-3122
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-02726225100000X
KS557734367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100412740DMedicaid
KS100412740DMedicaid