# ERICA MARIE WALL NURSE PRACTITIONER IN PSYCHIATRY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548016256
- **Authorized official:** MRS. ERICA MARIE WALL PMHNP-BC (OWNER)
- **Authorized official phone:** (518) 364-5854

## Contact information

- **Practice address:** 321 BROADWAY, RENSSELAER, NY 12144-2602
- **Practice address phone:** (518) 453-2280
- **Practice address fax:** (518) 453-2282
- **Mailing address:** 321 BROADWAY, RENSSELAER, NY 12144-2602
- **Mailing address phone:** (518) 453-2280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 04/24/2024
- **Last updated:** 04/25/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 07741220 | — | NY |
| 01 | — | 1083152136 | INDIVIDUAL NPI NUMBER | — |