Provider Demographics
NPI:1184310765
Name:WALTERS-THREAT, LOIS
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:WALTERS-THREAT
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 1:7330 STAPLES MILL RD # 285
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-4122
Mailing Address - Country:US
Mailing Address - Phone:804-724-7210
Mailing Address - Fax:
Practice Address - Street 1:9501 HULL STREET RD # NORTH
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-1474
Practice Address - Country:US
Practice Address - Phone:804-724-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186903363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health