Provider Demographics
NPI:1467574657
Name:WALTERS, LATOYA NICOLE
Entity Type:Individual
Prefix:MISS
First Name:LATOYA
Middle Name:NICOLE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SOPHIA CT
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7027
Mailing Address - Country:US
Mailing Address - Phone:203-238-5734
Mailing Address - Fax:203-235-6241
Practice Address - Street 1:44 SOPHIA CT
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-7027
Practice Address - Country:US
Practice Address - Phone:203-238-5734
Practice Address - Fax:203-235-6241
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTNA08090178376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide