Provider Demographics
NPI:1346219169
Name:WALSH, JENNIFER M (RN CPNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WALSH
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Gender:F
Credentials:RN CPNP
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Mailing Address - Street 1:1707 OSAGE ST
Mailing Address - Street 2:ALEXANDRIA LAKE RIDGE PEDIATRICS STE 104
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302
Mailing Address - Country:US
Mailing Address - Phone:703-212-6600
Mailing Address - Fax:703-931-0961
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:ALEXANDRIA LAKE RIDGE PEDIATRICS STE 500
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304
Practice Address - Country:US
Practice Address - Phone:703-212-6600
Practice Address - Fax:703-212-6606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VAPNP0024157708363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics