Provider Demographics
NPI:1548344856
Name:WALLNER, BARBARA J (FNP)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:J
Last Name:WALLNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:
Other - Last Name:ASHKINAZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78299 YUCCA BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-1315
Mailing Address - Country:US
Mailing Address - Phone:818-923-3910
Mailing Address - Fax:
Practice Address - Street 1:2133 WINTERHAVEN DRIVE
Practice Address - Street 2:
Practice Address - City:WINTERHAVEN
Practice Address - State:CA
Practice Address - Zip Code:92283
Practice Address - Country:US
Practice Address - Phone:760-538-3073
Practice Address - Fax:760-205-0016
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14096363LF0000X
AZ150372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily