Healthcare Provider Details

I. General information

NPI: 1881874428
Provider Name (Legal Business Name): BERNADETTE MARIE WALSH DNP, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 MOHAWK AVE
SPARTA NJ
07871-1808
US

IV. Provider business mailing address

21 MOHAWK AVE
SPARTA NJ
07871-1808
US

V. Phone/Fax

Practice location:
  • Phone: 973-729-4211
  • Fax:
Mailing address:
  • Phone: 973-729-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NO08389000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number26NJ00158400
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00158400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: