Healthcare Provider Details

I. General information

NPI: 1972262129
Provider Name (Legal Business Name): COUNTY OF LINCOLN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 SW COAST HWY STE 102
NEWPORT OR
97365-4988
US

IV. Provider business mailing address

36 SW NYE ST
NEWPORT OR
97365-3821
US

V. Phone/Fax

Practice location:
  • Phone: 541-265-0457
  • Fax:
Mailing address:
  • Phone: 541-265-0445
  • Fax: 844-760-0526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: LESA WAGNER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 541-265-0445