Provider Demographics
NPI:1699561852
Name:FIRN LINE WELLNESS LLC
Entity type:Organization
Organization Name:FIRN LINE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, CNM
Authorized Official - Phone:541-305-1321
Mailing Address - Street 1:431 NW FRANKLIN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2827
Mailing Address - Country:US
Mailing Address - Phone:503-828-2845
Mailing Address - Fax:
Practice Address - Street 1:431 NW FRANKLIN AVE STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2827
Practice Address - Country:US
Practice Address - Phone:541-305-7645
Practice Address - Fax:541-229-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500638416Medicaid