Provider Demographics
NPI:1902151319
Name:WALSH, MARY E (CPM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:WALSH
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 E GRAND ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0621
Mailing Address - Country:US
Mailing Address - Phone:417-380-7830
Mailing Address - Fax:
Practice Address - Street 1:1901 S VENTURA AVE STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2700
Practice Address - Country:US
Practice Address - Phone:417-233-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife