MEDICARE: MRS. LOIS STASH WALKER RN,CS

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	163WP0808X	Psychiatric/Mental Health Registered Nurse	0001067469	VA

General Provider Information

NPI Number	:	1437169422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOIS STASH WALKER RN,CS

Provider Business Mailing Address
First Line	:	10220 GROVEWOOD WAY
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22032-3252
Country	:	US
Telephone Number	:	703-978-2377
Fax Number	:

Provider Business Practice Location Address
First Line	:	3921 OLD LEE HWY
Second Line	:	SUITE 73A
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2429
Country	:	US
Telephone Number	:	703-758-4626
Fax Number	:

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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