=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619162039
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FAITH M WALSH RNC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2007
-----------------------------------------------------
Last Update Date | 09/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 FIRST AVE, SUITE 600 TANANA CHIEFS CONFERENCE
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-452-8251
-----------------------------------------------------
Fax | 907-459-3884
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1408 19TH AVE
-----------------------------------------------------
City | FAIRBANKS
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99701-5903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-451-6682
-----------------------------------------------------
Fax | 907-459-3976
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 20445
-----------------------------------------------------
License Number State | AK
-----------------------------------------------------