Provider Demographics
NPI:1720559602
Name:WALTERS, DANNA LEEALTHA
Entity Type:Individual
Prefix:
First Name:DANNA
Middle Name:LEEALTHA
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 1:7545 LAYTONIA DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-3854
Mailing Address - Country:US
Mailing Address - Phone:301-339-4922
Mailing Address - Fax:
Practice Address - Street 1:1616 MARION ST NW APT 235
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3473
Practice Address - Country:US
Practice Address - Phone:301-920-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC55148323OtherKAISER