Provider Demographics
NPI:1710314257
Name:WALSH, AMY CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CHRISTINE
Other - Last Name:HACKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 358
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3849
Mailing Address - Country:US
Mailing Address - Phone:312-942-5020
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 358
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3849
Practice Address - Country:US
Practice Address - Phone:312-942-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59764363A00000X
WI7475363AM0700X
IL085011274363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant