Healthcare Provider Details

I. General information

NPI: 1972419455
Provider Name (Legal Business Name): CARRIE PATTISON LAC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 NE 3RD PL
CAMAS WA
98607-1425
US

IV. Provider business mailing address

1518 NE 3RD PL
CAMAS WA
98607-1425
US

V. Phone/Fax

Practice location:
  • Phone: 503-267-3032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN70007549
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10053758
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACUP.AC.60210178
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: