Provider Demographics
NPI:1033386446
Name:HERBIG WALL, PAMELA LYNN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LYNN
Last Name:HERBIG WALL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1502 W NC HWY 54, STE 103
Mailing Address - Street 2:CAROLINA PARTNERS IN MENTAL HEALTHCARE, PLLC
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-0001
Mailing Address - Country:US
Mailing Address - Phone:919-354-0840
Mailing Address - Fax:
Practice Address - Street 1:1130 SITUS CT
Practice Address - Street 2:STE 190
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3391
Practice Address - Country:US
Practice Address - Phone:919-792-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533187363LP0808X
NC289390363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health