Active NPI
Alexander Kollie, LPN
- Licensed Practical Nurse
- Milwaukie, OR
National Provider Identifier
1073979712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 201507450LPN
- Practice address
- 10330 SE 32ND Ave Ste 110
Milwaukie, OR 97222-6596 - Phone
- (503) 525-8199
- NPI assigned
- Jan 11, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 201507450LPN | OR | Primary |
Addresses
Primary practice location
10330 SE 32ND Ave Ste 110
Milwaukie, OR 97222-6596
Mailing address
10330 SE 32ND Ave Ste 110
Milwaukie, OR 97222-6596
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201507450LPN | Other | OR | LPN LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 201507450LPN | OR | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452470400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1452470400000",
"number": "1073979712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10330 SE 32ND AVE STE 110",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972226596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10330 SE 32ND AVE STE 110",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972226596",
"telephone_number": "503-525-8199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOLLIE",
"first_name": "ALEXANDER",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-01-11",
"last_updated": "2016-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OR",
"license": "201507450LPN",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LPN LICENSE",
"identifier": "201507450LPN",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.