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General NPI Number Information
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NPI Number | 1205901493
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Entity Type | Individual
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Provider Name | KATINA WALLINE PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 1638 OWEN DR
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3424
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Country | US
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Telephone | 910-615-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 304 LARKTREE LN
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-7652
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Country | US
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Telephone | 773-320-0778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085-002067
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 186430
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License Number State | NC
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