Provider Demographics
NPI:1750665857
Name:CARRERA, MARILOU N (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARILOU
Middle Name:N
Last Name:CARRERA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8216 N BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-6805
Mailing Address - Country:US
Mailing Address - Phone:773-875-7979
Mailing Address - Fax:
Practice Address - Street 1:8216 N BRANDON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-6805
Practice Address - Country:US
Practice Address - Phone:773-875-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201040951RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health