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General NPI Number Information
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NPI Number | 1407776032
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Entity Type | Individual
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Provider Name | ELISA MICHELLE WALSH
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Gender | Female
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 12310 WOODCREEK DR STE E
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City | WILLIS
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State | TX
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Zip | 77318-7022
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Country | US
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Telephone | 936-243-3047
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Fax |
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Provider Business Mailing Address
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Address Line | 537 BROOK TERRANCE LN
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City | WILLIS
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State | TX
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Zip | 77378-6703
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Country | US
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Telephone | 303-374-4667
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1034605
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License Number State | TX
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