MEDICARE: MRS. LISA WALTERS RMA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		I DO NOT HAVE SUCH NUMBERS

General Provider Information

NPI Number	:	1427641190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA WALTERS RMA

Provider Business Mailing Address
First Line	:	1764 43RD ST SW
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-5932
Country	:	US
Telephone Number	:	239-601-6573
Fax Number	:

Provider Business Practice Location Address
First Line	:	1764 43RD ST SW
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34116-5932
Country	:	US
Telephone Number	:	239-601-6573
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2021
Last Update Date	:	02/14/2021

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