Active NPI
Mary Brooke Walsh, FNP
- Nurse Practitioner
- San Pablo, CA
National Provider Identifier
1992288716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95014926
- Practice address
- 100 San Pablo Towne Center
#A
San Pablo, CA 94505 - Phone
- (510) 237-2802
- NPI assigned
- Sep 7, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 343492 | NY | |
| Nurse Practitioner | 363L00000X | 95014926 | CA | Primary |
Addresses
Primary practice location
100 San Pablo Towne Center
#A
San Pablo, CA 94505
Mailing address
100 San Pablo Towne Center
#A
San Pablo, CA 94505
Phone (510) 237-2802
Other names 1
- Mary Piwinski
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 343492 | NY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pediatric Associates LLP | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatrics Physician
- Camillus, NY
- NPI 1932283348
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536278400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634083200000",
"number": "1992288716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 SAN PABLO TOWNE CENTER",
"address_2": "#A",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "94505",
"telephone_number": "510-237-2802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SAN PABLO TOWNE CENTER",
"address_2": "#A",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "94505",
"telephone_number": "510-237-2802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALSH",
"first_name": "MARY",
"middle_name": "BROOKE",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-07",
"last_updated": "2021-10-13",
"certification_date": "2021-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NY",
"license": "343492",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95014926",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARY",
"last_name": "PIWINSKI",
"code": "5",
"type": "Other Name"
}
]
}Other providers in San Pablo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.