Healthcare Provider Details

I. General information

NPI: 1992696249
Provider Name (Legal Business Name): CARRIE ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW HILLCREST CT
BEAVERTON OR
97008-6326
US

IV. Provider business mailing address

30 NE MARTIN LUTHER KING
PORTLAND OR
97232-2941
US

V. Phone/Fax

Practice location:
  • Phone: 408-221-9180
  • Fax:
Mailing address:
  • Phone: 408-221-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number200943015RN
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: