Provider Demographics
NPI:1679823744
Name:WALSH, AMY (LPN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11235 BUTTERNUT RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9326
Mailing Address - Country:US
Mailing Address - Phone:440-749-0694
Mailing Address - Fax:
Practice Address - Street 1:11235 BUTTERNUT RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9326
Practice Address - Country:US
Practice Address - Phone:440-749-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 149821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse