Provider Demographics
NPI:1649628082
Name:WALSH, MARY JANE (RN)
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JANE
Other - Last Name:MARSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23995 POINT LOOKOUT RD
Mailing Address - Street 2:LEONARDTOWN HIGH SCHOOL
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-4104
Mailing Address - Country:US
Mailing Address - Phone:301-475-0200
Mailing Address - Fax:301-475-0204
Practice Address - Street 1:23995 POINT LOOKOUT RD
Practice Address - Street 2:LEONARDTOWN HIGH SCHOOL
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-4104
Practice Address - Country:US
Practice Address - Phone:301-475-0200
Practice Address - Fax:301-475-0204
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR137211390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program