Individual
LUCILLE ELLEN BURNS WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1200 E MAIN ST, SUITE 12, SPARTANBURG, SC 29307-1711
(864) 560-9260
(864) 560-9265
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20874
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP4420
—
SC
01
—
SCA2355019
MEDICARE PIN
SC
01
—
SCA2356067
MEDICARE PTAN
SC
01
—
SCA2356121
MEDICARE PTAN
SC
01
—
SCA235J577
MEDICARE PIN
SC
Enumeration date
03/23/2017
Last updated
01/14/2021
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