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NPI Code Detail

MEDICARE: NICOLE WALSH

MEDICARE: NICOLE WALSH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1417799107
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE WALSH
Provider Business Mailing Address
First Line : 1547 30TH AVE S
Second Line :
City : MOORHEAD
State : MN
Zip : 56560-5149
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2145 NOKOMIS ST
Second Line :
City : ALEXANDRIA
State : MN
Zip : 56308-6412
Country : US
Telephone Number : 218-287-4338
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2024
Last Update Date : 08/13/2025

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Directions to “ NICOLE WALSH ” Practice Location

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