Provider Demographics
NPI:1588242044
Name:LEE, LOREN WALDEN (AGPCNP-BC, RN)
Entity type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:WALDEN
Last Name:LEE
Suffix:
Gender:F
Credentials:AGPCNP-BC, RN
Other - Prefix:MISS
Other - First Name:LOREN
Other - Middle Name:NICOLE
Other - Last Name:WALDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC, RN
Mailing Address - Street 1:107 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3825
Mailing Address - Country:US
Mailing Address - Phone:804-819-4000
Mailing Address - Fax:804-819-5221
Practice Address - Street 1:107 S 5TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-3825
Practice Address - Country:US
Practice Address - Phone:804-819-4000
Practice Address - Fax:804-819-5221
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001270374163W00000X
VA0024179895363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse