Provider Demographics
NPI:1891392312
Name:WALSH, DONNA LYNN (MS,RD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:WALSH
Suffix:
Gender:F
Credentials:MS,RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:ME
Mailing Address - Zip Code:04949-3133
Mailing Address - Country:US
Mailing Address - Phone:207-649-7422
Mailing Address - Fax:
Practice Address - Street 1:10 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:ME
Practice Address - Zip Code:04949-3133
Practice Address - Country:US
Practice Address - Phone:207-649-7422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI630133V00000X, 133VN1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1301XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Oncology