Provider Demographics
NPI:1497959274
Name:OLLISON, NACHERYL
Entity Type:Individual
Prefix:
First Name:NACHERYL
Middle Name:
Last Name:OLLISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 SE 143RD AVE
Mailing Address - Street 2:APT 8
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2756
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3410 SE 143RD AVE
Practice Address - Street 2:APT 8
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2756
Practice Address - Country:US
Practice Address - Phone:503-760-1536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion