Healthcare Provider Details

I. General information

NPI: 1750526299
Provider Name (Legal Business Name): ALISA PALLISTER BSN, RN, CCM, CNLCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 12/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 NW FRAZIER COURT
PORTLAND OR
97229-8489
US

IV. Provider business mailing address

1325 NW FRAZIER COURT
PORTLAND OR
97229-8489
US

V. Phone/Fax

Practice location:
  • Phone: 503-704-7019
  • Fax: 503-296-8529
Mailing address:
  • Phone: 503-704-7019
  • Fax: 503-296-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0970000215RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0970000215RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: