Healthcare Provider Details

I. General information

NPI: 1437169422
Provider Name (Legal Business Name): LOIS STASH WALKER RN,CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3921 OLD LEE HWY SUITE 73A
FAIRFAX VA
22030-2429
US

IV. Provider business mailing address

10220 GROVEWOOD WAY
FAIRFAX VA
22032-3252
US

V. Phone/Fax

Practice location:
  • Phone: 703-758-4626
  • Fax:
Mailing address:
  • Phone: 703-978-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001067469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: