1679508253 NPI number — ANGELA MCLEAN WALLING FNP

Table of content: ANGELA MCLEAN WALLING FNP (NPI 1679508253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679508253 NPI number — ANGELA MCLEAN WALLING FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALLING
Provider First Name:
ANGELA
Provider Middle Name:
MCLEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679508253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 CAPITAL DRIVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
CARTHAGE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28327-6261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-215-5110
Provider Business Mailing Address Fax Number:
910-215-0113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 CAPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
CARTHAGE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28327-6261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-215-5110
Provider Business Practice Location Address Fax Number:
910-245-3251
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  201682 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LX0001X , with the licence number: 201682 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8902144 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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