Individual
MRS. JODI ELIZABETH WALSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
61 BRADLEY ST STE 7, BRISTOL, CT 06010-5103
(860) 314-6898
(860) 314-6896
Mailing address
61 BRADLEY ST STE 7, BRISTOL, CT 06010-5103
(860) 314-6898
(860) 314-6896
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001279
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001279
LIC NUMBER
—
01
—
012790
CONNECTICARE ID#
—
Enumeration date
03/07/2006
Last updated
03/07/2023
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