Provider Demographics
NPI:1740013994
Name:CALISE, E'LAN C
Entity type:Individual
Prefix:
First Name:E'LAN
Middle Name:C
Last Name:CALISE
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 1:1827 SE 38TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5206
Mailing Address - Country:US
Mailing Address - Phone:503-960-0650
Mailing Address - Fax:503-214-7265
Practice Address - Street 1:2284 ROCK LEDGE DR NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-1810
Practice Address - Country:US
Practice Address - Phone:503-960-0650
Practice Address - Fax:503-214-7265
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201330176LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse