Provider Demographics
NPI:1952677122
Name:WALTERS, LYNNE M (RN)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
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 1:24206 NE 232ND AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-5022
Mailing Address - Country:US
Mailing Address - Phone:360-798-3291
Mailing Address - Fax:
Practice Address - Street 1:24206 NE 232ND AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-5022
Practice Address - Country:US
Practice Address - Phone:360-798-3291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201240091RN163W00000X
WARN60270888163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse