MEDICARE: MARY C WALSH N.P.

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
1	363L00000X	Nurse Practitioner	031724	AZ

General Provider Information

NPI Number	:	1619907904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C WALSH N.P.

Provider Business Mailing Address
First Line	:	1551 E TANGERINE RD
Second Line	:	ATTN: MEDICAL STAFF SERVICES
City	:	ORO VALLEY
State	:	AZ
Zip	:	85755-6213
Country	:	US
Telephone Number	:	520-901-3559
Fax Number	:	520-901-3642

Provider Business Practice Location Address
First Line	:	13101 N ORACLE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-9554
Country	:	US
Telephone Number	:	520-901-3559
Fax Number	:	520-901-3642

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/08/2007

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