Provider Demographics
NPI:1023015278
Name:SAFE HARBOR PEDIATRICS RURAL CLINIC
Entity Type:Organization
Organization Name:SAFE HARBOR PEDIATRICS RURAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WALLNER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, FNP
Authorized Official - Phone:503-861-7777
Mailing Address - Street 1:429 SE MARLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9649
Mailing Address - Country:US
Mailing Address - Phone:503-861-7777
Mailing Address - Fax:503-861-7771
Practice Address - Street 1:429 SE MARLIN AVE
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9649
Practice Address - Country:US
Practice Address - Phone:503-861-7777
Practice Address - Fax:503-861-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health