Provider Demographics
NPI:1164757589
Name:WALTERS, BRANDY LYNN (LC, BBA)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LC, BBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10911 CEDAR POST LN
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1627
Mailing Address - Country:US
Mailing Address - Phone:540-805-0041
Mailing Address - Fax:
Practice Address - Street 1:10911 CEDAR POST LN
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1627
Practice Address - Country:US
Practice Address - Phone:540-805-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-04
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA108-73235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist