Healthcare Provider Details

I. General information

NPI: 1699005652
Provider Name (Legal Business Name): CHRISTOPHER L. WALSH CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E SOUTH BLVD
MONTGOMERY AL
36116-2409
US

IV. Provider business mailing address

136 MEADOWLANE CT
WETUMPKA AL
36092-4198
US

V. Phone/Fax

Practice location:
  • Phone: 334-286-3579
  • Fax:
Mailing address:
  • Phone: 334-567-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-097549
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: