Healthcare Provider Details

I. General information

NPI: 1972771509
Provider Name (Legal Business Name): REBECCA ANN WALSH RN, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2008
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 E LANCASTER AVE
PAOLI PA
19301-1550
US

IV. Provider business mailing address

1044 BALLEY DR
PHOENIXVILLE PA
19460-5912
US

V. Phone/Fax

Practice location:
  • Phone: 610-647-4366
  • Fax:
Mailing address:
  • Phone: 610-850-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00154700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP009738
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: