Aishia Symone Wall, NP
Nurse Practitioner, Family in Fairport, NY. Individual provider (NPI-1).
NPI number1790331981
StatusActive
Last updated in NPPESAug 16, 2024
Details
- NPI
- 1790331981
- Entity type
- Individual (NPI-1)
- Name
- Aishia Symone Wall
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 13, 2019
- Certification date
- Aug 16, 2024
- Last updated
- Aug 16, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 352346 | NY | Yes |
| 163W00000X | Registered Nurse | 747632 | NY |
Practice location
41 Oconnor RdFairport, NY 14450-1327
Phone 585-383-2216
Mailing address
41 Oconnor RdFairport, NY 14450-1327
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