Individual
JAQUELINE CARRASCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA-C
Contact information
Practice address
2700 SIMPSON AVE STE 101, ABERDEEN, WA 98520-4333
(360) 612-0012
(360) 532-0670
Mailing address
PO BOX 1847, LONGVIEW, WA 98632-8140
(360) 353-9828
(360) 577-0269
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
CM60504139
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CM60504139
MA LICENSE
WA
Enumeration date
11/15/2019
Last updated
11/15/2019
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