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General NPI Number Information
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NPI Number | 1780217992
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Entity Type | Individual
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Provider Name | TIFFANY WALSH APRN
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Gender | Female
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Dates
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Enumeration Date | 02/16/2020
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Last Update Date | 02/16/2020
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 312-996-3988
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Fax |
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Provider Business Mailing Address
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Address Line | 6008 N AVONDALE AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3114
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Country | US
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Telephone | 415-559-1392
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 209.019376
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209.019376
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 209.019376
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License Number State | IL
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