Provider Demographics
NPI:1710352158
Name:WALSH, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN- CNP
Mailing Address - Street 1:462 STEVENS AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2065
Mailing Address - Country:US
Mailing Address - Phone:619-685-0649
Mailing Address - Fax:
Practice Address - Street 1:462 STEVENS AVE STE 206
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2065
Practice Address - Country:US
Practice Address - Phone:619-685-0649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020360363LW0102X
CA95003382363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health