Provider Demographics
NPI:1679980874
Name:WALSH, MARILYN ANNE (BSN)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 DRAKE LN
Mailing Address - Street 2:
Mailing Address - City:LEDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07852-9668
Mailing Address - Country:US
Mailing Address - Phone:973-349-4529
Mailing Address - Fax:
Practice Address - Street 1:85 DRAKE LN
Practice Address - Street 2:
Practice Address - City:LEDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07852-9668
Practice Address - Country:US
Practice Address - Phone:973-349-4529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-20
Last Update Date:2014-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ163WP0808X163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health