Provider Demographics
NPI:1225903552
Name:CARROLL, MICAELA
Entity type:Individual
Prefix:
First Name:MICAELA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6483 MCCOY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99129-9740
Mailing Address - Country:US
Mailing Address - Phone:509-828-3084
Mailing Address - Fax:
Practice Address - Street 1:6483 MCCOY LAKE RD
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:WA
Practice Address - Zip Code:99129-9740
Practice Address - Country:US
Practice Address - Phone:509-828-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-07
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula