Healthcare Provider Details

I. General information

NPI: 1902710239
Provider Name (Legal Business Name): LACEY FERRER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S ROOSEVELT ST
GOLDENDALE WA
98620-9201
US

IV. Provider business mailing address

7256 WAGON RD W
MOSIER OR
97040-9779
US

V. Phone/Fax

Practice location:
  • Phone: 541-980-2963
  • Fax:
Mailing address:
  • Phone: 541-980-2963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP70179620
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: