Healthcare Provider Details

I. General information

NPI: 1962573394
Provider Name (Legal Business Name): PAMELA SUE WALLS APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/23/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 22ND AVE NW SUITE U2
MINOT ND
58703
US

IV. Provider business mailing address

600 22ND AVE NW SUITE U2
MINOT ND
58703
US

V. Phone/Fax

Practice location:
  • Phone: 701-721-5143
  • Fax: 701-839-9071
Mailing address:
  • Phone: 701-721-5143
  • Fax: 701-839-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR-163958-0
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberR-29214
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR29214
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: