Healthcare Provider Details

I. General information

NPI: 1548344856
Provider Name (Legal Business Name): BARBARA J WALLNER F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA ASHKINAZE

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/18/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2133 WINTERHAVEN DRIVE
WINTERHAVEN CA
92283
US

IV. Provider business mailing address

78299 YUCCA BLOSSOM DR
PALM DESERT CA
92211-1315
US

V. Phone/Fax

Practice location:
  • Phone: 760-538-3073
  • Fax: 760-205-0016
Mailing address:
  • Phone: 818-923-3910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14096
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number150372
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: