Susan Walsh

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

209.003797 Issued in IL

Practice address

845 S Damen Ave
College of Nursing, Dept. of Wcfhs (MC 802)
Chicago, IL 60612-3727

Phone

(312) 355-4321

Fax

(312) 996-8871

NPI assigned

Nov 17, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Board of Trustees of the University of Illinois

  dba Medical Service Plan at Peoria

  • Pediatrics Physician
  • Peoria, IL
  • NPI 1467425322
  NPD (past)
• The Board of Trustees of the University of Illinois

  dba Integrated Health Care - AVIVA

  • Federally Qualified Health Center (FQHC)
  • Chicago, IL
  • NPI 1841614609
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447718400000",
    "number": "1285008003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2118 HARRISON ST",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600254955",
            "telephone_number": "847-436-0851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S DAMEN AVE",
            "address_2": "COLLEGE OF NURSING, DEPT. OF WCFHS (MC 802)",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123727",
            "telephone_number": "312-355-4321",
            "fax_number": "312-996-8871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "SUSAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-17",
        "last_updated": "2015-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": "209.003797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peter Thomas Walsh, MD
• Rita Walsh, DPT
• Ryan D Walsh
• Sherri Michelle Walsh, SLP
• Stephanie Walsh
• Susan Walsh, D.N., MED., ATCL
• Susan Frances Walsh, PH.D.
• Suzanne Marie Walsh, LCSW, JD
• Tessa Walsh, PT
• Tiffany Walsh, APRN

• Pediatric Nurse Practitioner in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.