Provider Demographics
NPI:1457949000
Name:WALL, JOYCE ELIZABETH (EDD, MSN, AGPCNP-C)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ELIZABETH
Last Name:WALL
Suffix:
Gender:F
Credentials:EDD, MSN, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3319
Mailing Address - Country:US
Mailing Address - Phone:203-215-8874
Mailing Address - Fax:
Practice Address - Street 1:1952 WHITNEY AVE STE 8
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1209
Practice Address - Country:US
Practice Address - Phone:203-848-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.009459363LA2200X
CT0000000000363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health