| Fern Lane Company, Llc | |
|
708 E Morris St Suite B La Conner WA 98257 | |
| (360) 630-5141 | |
| (866) 302-7491 |
| Full Name | Fern Lane Company, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 708 E Morris St, La Conner, Washington |
| Authorized Official Name and Position | Brianna Wilson (OWNER) |
| Authorized Official Contact | 3609415519 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fern Lane Company, Llc Po Box 2104 La Conner WA 98257-2104 Ph: (360) 630-5141 | Fern Lane Company, Llc 708 E Morris St Suite B La Conner WA 98257 Ph: (360) 630-5141 |
| NPI Number | 1497255293 |
|---|---|
| Provider Enumeration Date | 02/19/2018 |
| Last Update Date | 01/15/2020 |
| Medicare PECOS PAC ID | 0840540159 |
|---|---|
| Medicare Enrollment ID | O20180907001031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497255293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 261QP3300X | Clinic/center - Pain | (* (Not Available)) | Secondary |
| Provider Name | Brianna Jean Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083047369 PECOS PAC ID: 5698909109 Enrollment ID: I20131015001940 |
| Provider Name | Elizabeth Price |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649939083 PECOS PAC ID: 6901281047 Enrollment ID: I20220909002906 |
| Provider Name | Nicolette Felicia Liukko |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861221434 PECOS PAC ID: 9032640743 Enrollment ID: I20241006000124 |
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