Provider Demographics
NPI:1245976505
Name:WALSH, JERI LOU
Entity type:Individual
Prefix:
First Name:JERI
Middle Name:LOU
Last Name:WALSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 HILLPARK PL
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-4252
Mailing Address - Country:US
Mailing Address - Phone:541-660-5685
Mailing Address - Fax:541-803-7527
Practice Address - Street 1:1877 WILLIAMS HWY
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5802
Practice Address - Country:US
Practice Address - Phone:541-224-2068
Practice Address - Fax:541-830-7527
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200642925RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty