Provider Demographics
NPI:1174555395
Name:WALSH-WOLTERBEEK, COLLEEN ANNE (RN)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:WALSH-WOLTERBEEK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-4181
Mailing Address - Country:US
Mailing Address - Phone:603-354-7868
Mailing Address - Fax:603-354-7848
Practice Address - Street 1:441 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-4181
Practice Address - Country:US
Practice Address - Phone:603-354-7868
Practice Address - Fax:603-354-7848
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH039007-21163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management