Provider Demographics
NPI:1306034889
Name:WALTERS, RAQUEL (LPN)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5250
Mailing Address - Country:US
Mailing Address - Phone:212-222-5221
Mailing Address - Fax:212-222-8052
Practice Address - Street 1:565 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5250
Practice Address - Country:US
Practice Address - Phone:212-222-5221
Practice Address - Fax:212-222-8052
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286207164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse