Provider Demographics
NPI:1407870785
Name:WALSH, JUDITH A (RNC NP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:WALSH
Suffix:
Gender:F
Credentials:RNC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2014 WASHINGTON
Mailing Address - Street 2:KAPLAN JOINT CENTER GREEN 361 NEWTON WELLESLEY HOSPITAL
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462
Mailing Address - Country:US
Mailing Address - Phone:617-243-5155
Mailing Address - Fax:617-243-5090
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133482163WX0800X
MARN133482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08787OtherBLUE CROSS/BLUE SHEILD
MAJ08787OtherBLUE CROSS/BLUE SHEILD
MAS50059Medicare UPIN