Provider Demographics
NPI:1487888186
Name:WALSH, CORNELIA DEWITT (RN BC, BSN, MSHS)
Entity type:Individual
Prefix:MS
First Name:CORNELIA
Middle Name:DEWITT
Last Name:WALSH
Suffix:
Gender:F
Credentials:RN BC, BSN, MSHS
Other - Prefix:MS
Other - First Name:CORNELIA
Other - Middle Name:WALSH
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:585 LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-3225
Mailing Address - Country:US
Mailing Address - Phone:781-979-3337
Mailing Address - Fax:781-979-3496
Practice Address - Street 1:585 LEBANON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-3225
Practice Address - Country:US
Practice Address - Phone:781-979-3337
Practice Address - Fax:781-979-3496
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA146405163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health