Provider Demographics
NPI:1497460679
Name:PEREZ, CIARA NICHOLE (NP)
Entity Type:Individual
Prefix:
First Name:CIARA
Middle Name:NICHOLE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 OCHOCO LN
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-8032
Mailing Address - Country:US
Mailing Address - Phone:509-386-6664
Mailing Address - Fax:
Practice Address - Street 1:6210 OCHOCO LN
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-8032
Practice Address - Country:US
Practice Address - Phone:509-386-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61406177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily