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Organization
ERICA MARIE WALL NURSE PRACTITIONER IN PSYCHIATRY PLLC
Active
Organization
ERICA MARIE WALL NURSE PRACTITIONER IN PSYCHIATRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ERICA MARIE WALL PMHNP-BC (OWNER)
(518) 364-5854
Entity
Organization
Contact information
Practice address
321 BROADWAY, RENSSELAER, NY 12144-2602
(518) 453-2280
(518) 453-2282
Mailing address
321 BROADWAY, RENSSELAER, NY 12144-2602
(518) 453-2280
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07741220
—
NY
01
—
1083152136
INDIVIDUAL NPI NUMBER
—
Enumeration date
04/24/2024
Last updated
04/25/2024
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