Provider Demographics
NPI:1275033540
Name:HARBUCK, DANA LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LYNN
Last Name:HARBUCK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:LYNN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1226 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2716
Mailing Address - Country:US
Mailing Address - Phone:541-305-4224
Mailing Address - Fax:530-541-4227
Practice Address - Street 1:1226 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2716
Practice Address - Country:US
Practice Address - Phone:541-305-4224
Practice Address - Fax:530-541-4227
Is Sole Proprietor?:No
Enumeration Date:2018-02-13
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine