Healthcare Provider Details

I. General information

NPI: 1962334243
Provider Name (Legal Business Name): LISA MARIE WALTERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 STATE ROUTE 718
TROY OH
45373-8908
US

IV. Provider business mailing address

3145 STATE ROUTE 718
TROY OH
45373-8908
US

V. Phone/Fax

Practice location:
  • Phone: 937-332-3830
  • Fax: 937-332-3840
Mailing address:
  • Phone: 937-332-3830
  • Fax: 937-332-3840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-300880
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: