Healthcare Provider Details

I. General information

NPI: 1952122905
Provider Name (Legal Business Name): MEGAN WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10052 COORS BLVD NW
ALBUQUERQUE NM
87114-4020
US

IV. Provider business mailing address

10052 COORS BLVD NW
ALBUQUERQUE NM
87114-4020
US

V. Phone/Fax

Practice location:
  • Phone: 505-808-4327
  • Fax:
Mailing address:
  • Phone: 505-808-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD0956
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: