Provider Demographics
NPI:1508301201
Name:WALSH, OLIVIA S (PA)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:S
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4715 WHITESBURG DR SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1632
Mailing Address - Country:US
Mailing Address - Phone:256-881-5151
Mailing Address - Fax:256-880-3939
Practice Address - Street 1:4715 WHITESBURG DR SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1632
Practice Address - Country:US
Practice Address - Phone:256-881-5151
Practice Address - Fax:256-880-3939
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2019-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ALPA.1224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102I979793Medicare PIN