Provider Demographics
NPI:1053513903
Name:WALSH, DEANNE (APRN)
Entity type:Individual
Prefix:
First Name:DEANNE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 KNOLLCREST DR
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5332
Mailing Address - Country:US
Mailing Address - Phone:914-493-1271
Mailing Address - Fax:914-493-1806
Practice Address - Street 1:762 LINDLEY ST
Practice Address - Street 2:ST.VINCENT'S FAMILY HEALTH CENTER
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5046
Practice Address - Country:US
Practice Address - Phone:203-576-5131
Practice Address - Fax:203-576-5730
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2993363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily