Lisa Jo Walters, BSN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

R1647776 Issued in MN

Practice address

4815 Burning Tree Rd Ste 100
Duluth, MN 55811-3800

Phone

(218) 733-0707

Fax

(218) 733-0717

NPI assigned

Jul 18, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Healthstar / First Nations

  • Case Management Agency
  • Duluth, MN
  • NPI 1497298293
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1063935484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4815 BURNING TREE RD STE 100",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558113800",
            "telephone_number": "218-733-0707",
            "fax_number": "218-733-0717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4815 BURNING TREE RD STE 100",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558113800",
            "telephone_number": "218-733-0707",
            "fax_number": "218-733-0717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "LISA",
        "middle_name": "JO",
        "credential": "BSN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R1647776",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Diane Wallis, MS/CCC-SLP
• Evan M Walpole, OTR/L
• Annette L Walsh
• Nancy S Walsh
• Michael Neal Walter
• Stephanie Marie Walters, APRN, CNP
• Timothy R Walters, LPC
• Jeremy Lee Walton, MS, OTR/L
• Jenny Yunjie Wang, M.D.
• David Wangen

• Registered Nurse in Duluth, MN
• Providers in Duluth, MN by specialty
• Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.