Provider Demographics
NPI:1861656621
Name:MCMAKEN ROBERTS, ALISSA ZEA (CNM)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:ZEA
Last Name:MCMAKEN ROBERTS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:ZEA
Other - Last Name:MCMAKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7650 SW BEVELAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-601-3615
Mailing Address - Fax:503-646-1683
Practice Address - Street 1:1508 DIVISION ST
Practice Address - Street 2:STE 205
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1582
Practice Address - Country:US
Practice Address - Phone:503-657-1071
Practice Address - Fax:503-657-3321
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200850069NP NMNP176B00000X
OR200850069367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200850069NP NMNPOtherCNM LICENSE
OR279287Medicaid
OR200242145RNOtherRN LICENSE
OR279287Medicaid