Provider Demographics
NPI:1427641190
Name:WALTERS, LISA (RMA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1764 43RD ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-5932
Mailing Address - Country:US
Mailing Address - Phone:239-601-6573
Mailing Address - Fax:
Practice Address - Street 1:1764 43RD ST SW
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-5932
Practice Address - Country:US
Practice Address - Phone:239-601-6573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherI DO NOT HAVE SUCH NUMBERS