DR. SUSAN ANNE WALSTRA (NPI# 1790076453) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790076453 |
| Entity Type | Individual |
| Full Name | DR. SUSAN ANNE WALSTRA |
| Credential | M.D. |
| Practice Address |
4601 Heatherwind Dr Apt. D Fort Wayne IN 46815-7135 |
| Practice Telephone | 2604201433 |
| Practice Fax Number | 2607453643 |
| Mailing Telephone | 2604201433 |
| Mailing Fax Number | 2607453643 |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2011-04-28 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 01034161A | IN | Other Service Providers |
| Street Address |
4601 HEATHERWIND DR APT. D |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46815-7135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306305438 | Sullivan Services, Inc. | In Home Supportive Care | 2789-b Maplecrest Rd, Fort Wayne, IN 46815 | 2019-03-18 |
| 1598250144 | Altermease Gleason | Massage Therapist | 3406 Thames Drive, Fort Wayne, IN 46815 | 2018-06-26 |
| 1881000222 | Denise Sparks | Specialist | 6415 Benham Drive, Fort Wayne, IN 46815 | 2014-07-07 |
| 1962823138 | Chad Distelrath | Physical Therapy Assistant | 1717 Maplecrest Rd, Apt 112, Fort Wayne, IN 46815 | 2013-12-13 |
| 1689943409 | Kendall Joan Labrash | Physical Therapist | 4251 Lahmeyer Rd., Fort Wayne, IN 46815 | 2011-12-22 |
| 1801179718 | Jayson Laube | Pharmacist | 6201 Stellhorn, Fort Wayne, IN 46815 | 2011-09-27 |
| 1720294432 | Muscle Therapy Clinic LLC | Massage Therapist | 6409 Georgetown North Blvd, Fort Wayne, IN 46815 | 2007-05-16 |
| 1427186436 | Legoras Conture Fashions | Prosthetic/Orthotic Supplier | 3316 Inwood Drive, Fort Wayne, IN 46815 | 2007-03-01 |
| 1932252772 | Fort Wayne Smiles PC | Dentist | 2031 Reed Road, Fort Wayne, IN 46815 | 2007-01-18 |
| 1811078538 | Timothy Doody Lynch | Dentist | 4207 Hobson Court, Fort Wayne, IN 46815 | 2006-10-18 |
| Find all providers in zip 46815 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679078398 | Wright Choice Hairquarters | Specialist | 1815 Fox Point Trl Apt 2, Fort Wayne, IN 46816-2450 | 2018-03-26 |
| 1225581945 | Hossam Eldine Kamal Youssef | Specialist | 7230 Engle Rd Ste 303, Fort Wayne, IN 46804-2227 | 2016-07-28 |
| 1245600972 | Pediatric Cardiology Associates | Specialist | 5107 N Bend Dr, Fort Wayne, IN 46804-1753 | 2015-10-07 |
| 1598168197 | Melinda Elise Smith | Specialist | 5812 Maplecrest Rd, Fort Wayne, IN 46835-3840 | 2014-09-27 |
| 1881000222 | Denise Sparks | Specialist | 6415 Benham Drive, Fort Wayne, IN 46815 | 2014-07-07 |
| 1265755250 | William A Argus Md PC | Specialist | 7030 Pointe Inverness Way Ste 240, Fort Wayne, IN 46804-7925 | 2010-03-05 |
| 1033376413 | A Step Ahead Therapies, LLC | Specialist | 6013 Belle Isle Ln, Fort Wayne, IN 46835-1263 | 2008-05-21 |
| 1932370590 | Kerri Jo Trentacosti | Specialist | 5939 Brighton Meadows Dr, Apt. C, Fort Wayne, IN 46804-7664 | 2008-03-21 |
| 1649458662 | Bernice Wilson | Specialist | 4202 Buell Dr, Fort Wayne, IN 46807-2743 | 2008-01-31 |
| 1942498266 | Michelle P Berry | Specialist | 6205 Constitution Dr, Fort Wayne, IN 46804-1517 | 2007-10-11 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46815 |
Please comment or provide details below to improve the information on DR. SUSAN ANNE WALSTRA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.