Individual
CARLY LYNNE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
9955 POPLAR TENT RD, CONCORD, NC 28027-9314
(704) 316-4828
(704) 316-4829
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
CNM699
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CNM04927
MIDWIFERY JOINT COMMITTEE OF THE STATE OF NORTH CAROLINA
NC
Enumeration date
06/26/2018
Last updated
06/30/2022
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