Provider Demographics
NPI:1285189530
Name:CARREON, MIGUEL D (DNP, FNP-C, AAHIVS)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:D
Last Name:CARREON
Suffix:
Gender:M
Credentials:DNP, FNP-C, AAHIVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 SE KING ROAD PMB 235
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222
Mailing Address - Country:US
Mailing Address - Phone:971-266-3325
Mailing Address - Fax:503-212-9040
Practice Address - Street 1:1818 NE IRVING ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2238
Practice Address - Country:US
Practice Address - Phone:503-719-4827
Practice Address - Fax:503-719-6224
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606485NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily