Healthcare Provider Details

I. General information

NPI: 1831795996
Provider Name (Legal Business Name): JERUSHA LATTERI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E23
HERMISTON OR
97838-8603
US

IV. Provider business mailing address

600 NW 11TH ST STE E23
HERMISTON OR
97838-8603
US

V. Phone/Fax

Practice location:
  • Phone: 541-667-3661
  • Fax: 541-275-8796
Mailing address:
  • Phone: 541-667-3661
  • Fax: 541-275-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202101519NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number202101519NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: