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
—
—
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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