Provider Demographics
NPI:1821518648
Name:WALTERS, LOLETA (RN)
Entity Type:Individual
Prefix:
First Name:LOLETA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11634 233RD ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11411-1836
Mailing Address - Country:US
Mailing Address - Phone:718-276-1746
Mailing Address - Fax:718-276-1746
Practice Address - Street 1:11634 233ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11411-1836
Practice Address - Country:US
Practice Address - Phone:718-276-1746
Practice Address - Fax:718-276-1746
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY277087-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse