Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 289390 | NC |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 533187 | CA |
NPI | 1033386446 |
---|---|
Provider Name | Ms. Pamela Lynn Herbig Wall |
First Address | Durham, NC 27707-0001 |
Second Address | Raleigh, NC 27606-3391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2008 |
Last Update Date | 17/02/2017 |