Provider Demographics
NPI:1619162039
Name:WALSH, FAITH M (RNC)
Entity Type:Individual
Prefix:MRS
First Name:FAITH
Middle Name:M
Last Name:WALSH
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5903
Mailing Address - Country:US
Mailing Address - Phone:907-451-6682
Mailing Address - Fax:907-459-3976
Practice Address - Street 1:122 FIRST AVE, SUITE 600
Practice Address - Street 2:TANANA CHIEFS CONFERENCE
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:907-459-3884
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK20445163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK0Medicaid