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General NPI Number Information
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NPI Number | 1427095280
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Entity Type | Individual
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Provider Name | ROBERT BRIAN WALL NP
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 11/15/2013
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Provider Practice Location Address
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Address Line | 6 GLEN COVE DR
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City | ROCKPORT
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State | ME
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Zip | 04856-4240
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Country | US
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Telephone | 207-596-8215
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Fax |
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Provider Business Mailing Address
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Address Line | 6 GLEN COVE DR
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City | ROCKPORT
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State | ME
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Zip | 04856-4240
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Country | US
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Telephone | 207-596-8215
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 258647
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 258647
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 258647
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP131013
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License Number State | ME
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | CNP131013
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License Number State | ME
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