Provider Demographics
NPI:1548894157
Name:WALSH, EMILY ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ROSE
Other - Last Name:PULTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2479 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4758
Mailing Address - Country:US
Mailing Address - Phone:248-918-1703
Mailing Address - Fax:
Practice Address - Street 1:2773 HARRIS ST STE A
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4866
Practice Address - Country:US
Practice Address - Phone:707-442-1182
Practice Address - Fax:707-442-1635
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATPA10007363A00000X
WAPA61156441363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant