Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | F308267-1 | NY |
NPI | 1013434927 |
---|---|
Provider Name | Kelly Ann Walsh |
First Address | Sewaren, NJ 07077-1242 |
Second Address | New York, NY 10016-4974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2017 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F308267-1 | LICENSE NUMBER (01) | NY |