Provider Demographics
NPI:1881811545
Name:WALSH, ANNE MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MARIE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:351 HOSPITAL ROAD
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3506
Mailing Address - Country:US
Mailing Address - Phone:949-646-7733
Mailing Address - Fax:949-646-6155
Practice Address - Street 1:351 HOSPITAL ROAD
Practice Address - Street 2:SUITE 406
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3506
Practice Address - Country:US
Practice Address - Phone:949-646-7733
Practice Address - Fax:949-646-6155
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15511363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant