Healthcare Provider Details

I. General information

NPI: 1629080411
Provider Name (Legal Business Name): WALTER A LUMLEY RNC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

447 GREENWOOD DR WOOD CREEK
WILMINGTON DE
19808-1961
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax:
Mailing address:
  • Phone: 215-823-4175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN169810L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: