Provider Demographics
NPI:1922071182
Name:WAHLS, MONICA M (FNP, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:M
Last Name:WAHLS
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:MISS
Other - First Name:MONICA
Other - Middle Name:M
Other - Last Name:YEDINAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6048
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6048
Mailing Address - Country:US
Mailing Address - Phone:541-382-4900
Mailing Address - Fax:541-706-2398
Practice Address - Street 1:1501 NE MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6051
Practice Address - Country:US
Practice Address - Phone:541-382-4900
Practice Address - Fax:541-706-2398
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201391720NP-PP363LP0808X
OR200150011NP-FNP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORJ406428OtherIND PACSOURCE
OR000188021OtherIND BLUE CROSS
OR500027207OtherIND RAILROAD
OR000164Medicaid
OR000164Medicaid
OR000164Medicaid