Individual provider · Type 1 NPI

Staci L. Wall, NP

Nurse Practitioner · Fort Wayne, IN

NPI number 1629068291 Active

Practice location

7988 W Jefferson Blvd
Fort Wayne, IN 46804-4140

Call (260) 432-4400 Map

Fax (260) 969-6898

Mailing address

2518 E Dupont Rd
Fort Wayne, IN 46825-1675

Specialties and licenses

TaxonomyCodeLicense
Registered Nurse 163W00000X28086186 (IN)
Nurse Practitioner Primary 363L00000X71003769 (IN)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1629068291

Staci L. Wall, NP's National Provider Identifier is 1629068291, issued on Oct 25, 2005. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Fort Wayne, IN. The record was last updated on Jan 31, 2018.