Healthcare Provider Details

I. General information

NPI: 1033566773
Provider Name (Legal Business Name): DALLAS M WALSH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 126Q
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

100 CUMMINGS CTR SUITE 126Q
BEVERLY MA
01915-6115
US

V. Phone/Fax

Practice location:
  • Phone: 978-524-8181
  • Fax:
Mailing address:
  • Phone: 978-524-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2265856
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: