Provider Demographics
NPI:1629383898
Name:WALSH- YOUNG, MARIE (LPN, LMT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:WALSH- YOUNG
Suffix:
Gender:F
Credentials:LPN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 OAK RIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-3411
Mailing Address - Country:US
Mailing Address - Phone:404-423-8062
Mailing Address - Fax:
Practice Address - Street 1:207 OAK RIDGE DR SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-3411
Practice Address - Country:US
Practice Address - Phone:404-423-8062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula