Healthcare Provider Details

I. General information

NPI: 1760224331
Provider Name (Legal Business Name): K. BRANDI LACRE ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHARYN BRANDI LACRE ND

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 SW CENTURY DR STE 100-1079
BEND OR
97702-3557
US

IV. Provider business mailing address

2976 E STATE ST STE 120
EAGLE ID
83616-6394
US

V. Phone/Fax

Practice location:
  • Phone: 541-977-7078
  • Fax:
Mailing address:
  • Phone: 385-743-2584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateID
# 7
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOR
# 12
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR
# 13
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 14
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number110802
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: