Provider Demographics
NPI:1700761392
Name:WALLENDER, REBECCA VIOLET (LPN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:VIOLET
Last Name:WALLENDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3205
Mailing Address - Country:US
Mailing Address - Phone:206-406-4848
Mailing Address - Fax:
Practice Address - Street 1:17968 S HOLLY LN
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9011
Practice Address - Country:US
Practice Address - Phone:971-346-6314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201803191LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse