Provider Demographics
NPI:1750265344
Name:ST CLAIR, TAKARA
Entity type:Individual
Prefix:
First Name:TAKARA
Middle Name:
Last Name:ST CLAIR
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 1:155 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-4419
Mailing Address - Country:US
Mailing Address - Phone:509-301-0822
Mailing Address - Fax:
Practice Address - Street 1:155 LEONARD ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-4419
Practice Address - Country:US
Practice Address - Phone:509-301-0822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula