Provider Demographics
NPI:1710086285
Name:WALSH, JENNIFER (RNC, MS, WHCNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:RNC, MS, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WARDENBURG DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-0001
Mailing Address - Country:US
Mailing Address - Phone:303-492-5432
Mailing Address - Fax:
Practice Address - Street 1:1900 WARDENBURG DRIVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-1309
Practice Address - Country:US
Practice Address - Phone:303-492-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO163911363LW0102X
CORXN.0009015.NP363LW0102X
COAPN.0005020-NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22735038Medicaid