Provider Demographics
NPI:1679508253
Name:WALLING, ANGELA M (MSN FNPC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:WALLING
Suffix:
Gender:F
Credentials:MSN FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 US 1 HWY
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-9311
Mailing Address - Country:US
Mailing Address - Phone:910-215-0111
Mailing Address - Fax:910-215-0113
Practice Address - Street 1:3349 US 1 HWY
Practice Address - Street 2:
Practice Address - City:VASS
Practice Address - State:NC
Practice Address - Zip Code:28394-0647
Practice Address - Country:US
Practice Address - Phone:102-457-6789
Practice Address - Fax:910-245-3251
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201682363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902144Medicaid
NC8902144Medicaid
NC2809454BMedicare PIN