Provider Demographics
NPI:1538438882
Name:WALCZYK, LORI CHRISTINE (CPNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:CHRISTINE
Last Name:WALCZYK
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9517 MIRANDA DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7669
Mailing Address - Country:US
Mailing Address - Phone:919-846-9405
Mailing Address - Fax:
Practice Address - Street 1:5524 HOSPITAL N
Practice Address - Street 2:100500 MED CENTER
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-0001
Practice Address - Country:US
Practice Address - Phone:919-681-5551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004475363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics