Healthcare Provider Details

I. General information

NPI: 1588242044
Provider Name (Legal Business Name): LOREN WALDEN LEE AGPCNP-BC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LOREN NICOLE WALDEN AGPCNP-BC, RN

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 5TH ST
RICHMOND VA
23219-3825
US

IV. Provider business mailing address

107 S 5TH ST
RICHMOND VA
23219-3825
US

V. Phone/Fax

Practice location:
  • Phone: 804-819-4000
  • Fax: 804-819-5221
Mailing address:
  • Phone: 804-819-4000
  • Fax: 804-819-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number0024179895
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024179895
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001270374
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: