Provider Demographics
NPI:1780208405
Name:WALSH, DESIRAY
Entity Type:Individual
Prefix:
First Name:DESIRAY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13A FORREST RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03276-4050
Mailing Address - Country:US
Mailing Address - Phone:603-409-0469
Mailing Address - Fax:
Practice Address - Street 1:46 HUBBARD RD
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03901-2342
Practice Address - Country:US
Practice Address - Phone:603-409-1482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH374U00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide