Provider Demographics
NPI:1922479856
Name:WALSH, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
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 1:122 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1531
Mailing Address - Country:US
Mailing Address - Phone:845-534-8009
Mailing Address - Fax:845-534-8309
Practice Address - Street 1:122 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1531
Practice Address - Country:US
Practice Address - Phone:845-534-8009
Practice Address - Fax:845-534-8309
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287514163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse