Healthcare Provider Details

I. General information

NPI: 1588272710
Provider Name (Legal Business Name): ALLISON JANE O'MEARA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1859 NW CIVIC DR
GRESHAM OR
97030-5566
US

IV. Provider business mailing address

PO BOX 31001-4180
PASADENA CA
91110-4180
US

V. Phone/Fax

Practice location:
  • Phone: 503-962-1000
  • Fax:
Mailing address:
  • Phone: 503-215-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202003501NP-PP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: