Provider Demographics
NPI:1235221672
Name:WALSH, ALICIA S (APRN CPNP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:S
Last Name:WALSH
Suffix:
Gender:F
Credentials:APRN CPNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:92 NEW LONDON TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:92 NEW LONDON TURNPIKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-889-3401
Practice Address - Fax:860-823-1782
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002631363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
230002361CT01OtherBLUECARE FAMILY PLAN
026310OtherCONNECTICARE
230002361CT01OtherHUSKY B
400002631CT01OtherANTHEM BLUE CROSS
P3599013OtherOXFORD UNITED HEALTHCARE
2V6241OtherHEALTHNET