Provider Demographics
NPI:1073259651
Name:WALSH, CHRISTINE MARIE (AGNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 AMHERST AVE # A
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3840
Mailing Address - Country:US
Mailing Address - Phone:406-498-9236
Mailing Address - Fax:
Practice Address - Street 1:100 GARNET WAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756-9705
Practice Address - Country:US
Practice Address - Phone:406-693-7000
Practice Address - Fax:406-693-7267
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT194354363LG0600X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1073259651Medicaid
MTNUR-APRN-LIC194354OtherBOARD OF NURSING