Provider Demographics
NPI:1023328598
Name:WALSH, NANCY (CRNA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 BLUE GRASS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1916
Mailing Address - Country:US
Mailing Address - Phone:410-340-9422
Mailing Address - Fax:
Practice Address - Street 1:10 NORTH GREENE STREET
Practice Address - Street 2:VA MARYLAND HEALTH CARE SYSTEM
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1524
Practice Address - Country:US
Practice Address - Phone:410-605-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR167652367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered