Individual provider · Type 1 NPI
Matthew Lucas Wall
Pediatric Nurse Practitioner · Philadelphia, PA
NPI number
1821746777
Active
Practice location
3401 Civic Center Blvd
Philadelphia, PA 19104-4319
Mailing address
14 Martin Rd
Coatesville, PA 19320-4916
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Pediatric Nurse Practitioner Primary | 363LP0200X | SP025443 (PA) |
Pediatric Nurse Practitioner: Definition to come...
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About NPI 1821746777
Matthew Lucas Wall's National Provider Identifier is 1821746777, issued on Mar 10, 2022. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Philadelphia, PA. The record was last updated on Mar 10, 2022.