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Tabitha Waller, FNP
Family Nurse Practitioner in Roseburg, Oregon
NPI 1619410982

Tabitha Waller is a Family Nurse Practitioner based in Roseburg, OR and is specialized in Family. Tabitha Waller practices in Roseburg, OR and has the professional credentials of FNP. The NPI Number for Tabitha Waller is 1619410982 and holds a License No. 20160204NP-PP (Oregon).

The current practice location address for Tabitha Waller is 1813 W Harvard Ave, Roseburg, OR and can be reached out via phone at 541-440-6390.

Location: 1813 W Harvard Ave, Roseburg, OR, 97471-2752
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1619410982
Provider Name
Tabitha Waller
Credential
FNP
Provider Entity Type
Individual
Gender
Female
Address
1813 W Harvard Ave, Roseburg, OR, 97471-2752
Phone Number
541-440-6390
Fax Number
Provider Enumeration Date
11/18/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
20160204NP-PP 01 OR STATE LICENSE
institution
Provider Business Practice Location Address Details
Address
1813 W Harvard Ave
City
Roseburg
State
Oregon
Zip
97471-2752
Phone Number
541-440-6390
Fax Number
person
Provider Business Mailing Address Details
Address
1813 W Harvard Ave
City
Roseburg
State
Oregon
Zip
97471-2752
Phone Number
541-440-6390
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
20160204NP-PP (Oregon)
Definition
Definition to come...
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