Provider Demographics
NPI:1073591632
Name:WALTERS, LINDA T (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:T
Last Name:WALTERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 EXECUTIVE AVE
Mailing Address - Street 2:APT D-1
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-2118
Mailing Address - Country:US
Mailing Address - Phone:703-519-1725
Mailing Address - Fax:703-519-1738
Practice Address - Street 1:3804 EXECUTIVE AVE
Practice Address - Street 2:APT D-1
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22305-2118
Practice Address - Country:US
Practice Address - Phone:703-519-1725
Practice Address - Fax:703-519-1738
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024056328363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01563A02Medicare PIN
Q16893Medicare UPIN