Provider Demographics
NPI:1649515107
Name:WALTERS, LYNNE B (RN, LMP)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:B
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN, LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 SW 248TH ST
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-8005
Mailing Address - Country:US
Mailing Address - Phone:206-463-2709
Mailing Address - Fax:
Practice Address - Street 1:7003 SW 248TH ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-8005
Practice Address - Country:US
Practice Address - Phone:206-463-2709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN00062664163W00000X
WAMA00003845163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)
No163W00000XNursing Service ProvidersRegistered Nurse