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General NPI Number Information
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NPI Number | 1245781590
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Entity Type | Individual
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Provider Name | LEIGH WALL NP-C
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Gender | Female
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Dates
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Enumeration Date | 10/21/2016
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 4325 LAKE BOONE TRL STE 315
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City | RALEIGH
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State | NC
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Zip | 27607-7510
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Country | US
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Telephone | 984-974-0498
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Fax | 984-974-0499
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Provider Business Mailing Address
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Address Line | 4325 LAKE BOONE TRL STE 315
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City | RALEIGH
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State | NC
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Zip | 27607-7510
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Country | US
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Telephone | 954-974-0498
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Fax | 984-974-0499
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0024174122
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License Number State | VA
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