MEDICARE: MS. EILEEN P WALSH MSN,FNP

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	363LF0000X	Family Nurse Practitioner	8912	CA

General Provider Information

NPI Number	:	1942476064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EILEEN P WALSH MSN,FNP

Provider Business Mailing Address
First Line	:	326 W ELM AVE
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91506-3318
Country	:	US
Telephone Number	:	818-556-3939
Fax Number	:	818-887-5577

Provider Business Practice Location Address
First Line	:	212 S MAPLE DR
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4014
Country	:	US
Telephone Number	:	424-221-4122
Fax Number	:

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

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	07/21/2022

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