Provider Demographics
NPI:1841339629
Name:AHALT, LOIS ELLEN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:ELLEN
Last Name:AHALT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:ELLEN
Other - Last Name:MINCHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2406 HUNTERS CHASE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2616
Mailing Address - Country:US
Mailing Address - Phone:301-514-5735
Mailing Address - Fax:
Practice Address - Street 1:8300 RESEARCH PLAZA
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9210
Practice Address - Country:US
Practice Address - Phone:301-619-5540
Practice Address - Fax:301-619-5591
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR070660163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health