Healthcare Provider Details

I. General information

NPI: 1679245559
Provider Name (Legal Business Name): CHRISTINE MARIE ALLEN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12121 E BURNSIDE ST
PORTLAND OR
97216-3737
US

IV. Provider business mailing address

12121 E BURNSIDE ST
PORTLAND OR
97216-3737
US

V. Phone/Fax

Practice location:
  • Phone: 971-361-7700
  • Fax:
Mailing address:
  • Phone: 971-361-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10029830
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201140242RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: