Provider Demographics
NPI:1215694906
Name:WALTERS, LISA (CD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 N PRINCE WILLIAM LOOP
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-0050
Mailing Address - Country:US
Mailing Address - Phone:574-612-1281
Mailing Address - Fax:
Practice Address - Street 1:9515 N PRINCE WILLIAM LOOP
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-0050
Practice Address - Country:US
Practice Address - Phone:574-612-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula