Healthcare Provider Details

I. General information

NPI: 1457949000
Provider Name (Legal Business Name): JOYCE ELIZABETH WALL EDD, MSN, AGPCNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/16/2023
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1952 WHITNEY AVE STE 8
HAMDEN CT
06517-1209
US

IV. Provider business mailing address

238 S MAIN ST
SEYMOUR CT
06483-3319
US

V. Phone/Fax

Practice location:
  • Phone: 203-848-1803
  • Fax:
Mailing address:
  • Phone: 203-215-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12.009459
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0000000000
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: