Provider Demographics
NPI:1750526299
Name:PALLISTER, ALISA (BSN, RN, CCM, CNLCP)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:PALLISTER
Suffix:
Gender:F
Credentials:BSN, RN, CCM, CNLCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 NW FRAZIER COURT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-8489
Mailing Address - Country:US
Mailing Address - Phone:503-704-7019
Mailing Address - Fax:503-296-8529
Practice Address - Street 1:1325 NW FRAZIER COURT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-8489
Practice Address - Country:US
Practice Address - Phone:503-704-7019
Practice Address - Fax:503-296-8529
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0970000215RN163WC0400X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC0400XNursing Service ProvidersRegistered NurseCase Management