Provider Demographics
NPI:1982437208
Name:WALSH, DANIELLE ROSE (APNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ROSE
Last Name:WALSH
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ROSE
Other - Last Name:TADYSHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1636 LINDALE LN
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-5511
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1516 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3045
Practice Address - Country:US
Practice Address - Phone:920-793-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15857-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily