1174624126 NPI number — MRS. SHARON LYNN MCALLISTER PMHNP

Table of content: MRS. SHARON LYNN MCALLISTER PMHNP (NPI 1174624126)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174624126 NPI number — MRS. SHARON LYNN MCALLISTER PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCALLISTER
Provider First Name:
SHARON
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174624126
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5520 SW MACADAM AVE
Provider Second Line Business Mailing Address:
SUITE 190
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97239-3768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-243-2846
Provider Business Mailing Address Fax Number:
503-243-3635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5520 SW MACADAM AVE
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97239-3768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-243-2846
Provider Business Practice Location Address Fax Number:
503-243-3635
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0809X , with the licence number:  000033081N6 PMHNP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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