Provider Demographics
NPI:1437897436
Name:WALSH, TERESA LOUISE (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:LOUISE
Last Name:WALSH
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 ALDRICH CT
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4902
Mailing Address - Country:US
Mailing Address - Phone:781-812-8779
Mailing Address - Fax:
Practice Address - Street 1:39 ALDRICH CT
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4902
Practice Address - Country:US
Practice Address - Phone:781-812-8779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist