Provider Demographics
NPI:1407811649
Name:WALSH, DORIS K (CRNA)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:K
Last Name:WALSH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E WING ST
Mailing Address - Street 2:#182
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-6064
Mailing Address - Country:US
Mailing Address - Phone:866-839-7136
Mailing Address - Fax:866-245-7239
Practice Address - Street 1:126 E WING ST
Practice Address - Street 2:#182
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-6064
Practice Address - Country:US
Practice Address - Phone:866-839-7136
Practice Address - Fax:866-245-7239
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003159367500000X
IL041-122991163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL90010Medicare ID - Type Unspecified
ILL90012Medicare ID - Type Unspecified
ILL90011Medicare ID - Type Unspecified