Healthcare Provider Details

I. General information

NPI: 1609884162
Provider Name (Legal Business Name): MICHELLE WALSH PHD CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

3275 CRANSTON DR
DUBLIN OH
43017-3702
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-3865
  • Fax: 614-722-6560
Mailing address:
  • Phone: 614-889-1824
  • Fax: 614-722-6560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN209187
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA01020NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: