Healthcare Provider Details

I. General information

NPI: 1457297517
Provider Name (Legal Business Name): JAQUELINE CARRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 N TOWNSEND RD
HERMISTON OR
97838-6769
US

IV. Provider business mailing address

1605 N TOWNSEND RD
HERMISTON OR
97838-6769
US

V. Phone/Fax

Practice location:
  • Phone: 458-255-8461
  • Fax:
Mailing address:
  • Phone: 458-255-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: