Provider Demographics
NPI:1366888208
Name:WALSH, JENNIFER LYNN (ANP-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:WALSH
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
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Mailing Address - Street 1:345 EXECUTIVE PKWY
Mailing Address - Street 2:STE M4
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7911
Mailing Address - Country:US
Mailing Address - Phone:847-305-1954
Mailing Address - Fax:815-229-9430
Practice Address - Street 1:1420 S BARRINGTON RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5206
Practice Address - Country:US
Practice Address - Phone:847-382-6664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-19
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010173363LA2200X
IL041.341540163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse