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Individual
RENEE V. WALL
Active
Individual
RENEE V. WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-04392
NC
363A00000X
Physician Assistant
PA18633
CA
363A00000X
Physician Assistant
PA60150098
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-04392
NC LICENSE
NC
Enumeration date
12/13/2006
Last updated
09/30/2013
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