Provider Demographics
NPI:1336659143
Name:WALSH, DONNA LYNN (RN)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:WALSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PRESCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3216
Mailing Address - Country:US
Mailing Address - Phone:917-440-4851
Mailing Address - Fax:917-440-4851
Practice Address - Street 1:165 PRESCOTT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3216
Practice Address - Country:US
Practice Address - Phone:917-440-4851
Practice Address - Fax:917-440-4851
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY366427-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse