Healthcare Provider Details

I. General information

NPI: 1831867894
Provider Name (Legal Business Name): ALLYSON MARIE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2021
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 NW LOVEJOY ST STE 304
PORTLAND OR
97210-5100
US

IV. Provider business mailing address

2730 S MOODY AVE
PORTLAND OR
97201-5042
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-4992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA217469
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: