Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 2005026118 | MO |
NPI | 1518916030 |
---|---|
Provider Name | Dr. Christine Mary Walsh-Kelly |
First Address | Elm Grove, WI 53122-2237 |
Second Address | Kansas City, MO 64108-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 30/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207471103 | (05) | MO |
E48033 | (02) |