Healthcare Provider Details

I. General information

NPI: 1033259221
Provider Name (Legal Business Name): NANCY R WALSH NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BRYANT ST
BUFFALO NY
14222-2006
US

IV. Provider business mailing address

3251 S CREEK RD
HAMBURG NY
14075-6167
US

V. Phone/Fax

Practice location:
  • Phone: 716-878-7481
  • Fax: 716-888-3811
Mailing address:
  • Phone: 716-649-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number300545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: