Provider Demographics
NPI:1447437272
Name:WALSH, LYNNE CLAIRE (ARNP)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:CLAIRE
Last Name:WALSH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LYNNE
Other - Middle Name:CLAIRE
Other - Last Name:KOERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1110 112TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4509
Mailing Address - Country:US
Mailing Address - Phone:425-749-3324
Mailing Address - Fax:425-688-8110
Practice Address - Street 1:1110 112TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4509
Practice Address - Country:US
Practice Address - Phone:425-749-3324
Practice Address - Fax:425-688-8110
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30008020363LP1700X, 363LA2200X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatal
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP30008020OtherWA ARNP LICENSE