Provider Demographics
NPI:1528217585
Name:TAKEO, ALISON KAY (FNP)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:KAY
Last Name:TAKEO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:KAY
Other - Last Name:MASSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:6707 SW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-2017
Mailing Address - Country:US
Mailing Address - Phone:503-309-6701
Mailing Address - Fax:
Practice Address - Street 1:435 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4729
Practice Address - Country:US
Practice Address - Phone:503-585-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350069NP FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily