Healthcare Provider Details

I. General information

NPI: 1871291021
Provider Name (Legal Business Name): ASHLEY WALL PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BELMONT AVE
YOUNGSTOWN OH
44505-2405
US

IV. Provider business mailing address

12 STONE FENCE DR
DERRY NH
03038-4709
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-1015
  • Fax: 330-743-1025
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0033298
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: