Allison Dao, NURSE PRACTITIONER
Individual provider Active NPI Family Nurse Practitioner · Nantucket, MA
NPI 1689885485 · NPPES record last updated Jun 27, 2023
Key facts
- NPI
- 1689885485
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- AP3112 (AZ)
- Practice address
- 57 Prospect St
Nantucket, MA 02554-2799 - Phone
- (508) 825-8100
- NPI assigned
- May 24, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200602001728 | OR | Practitioner - Nurse Practitioner | 1759457302 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16809 | CA | MD | Chiropractor |
| 1039 | AK | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Icco, LLC | Current |
Accepting new patients | |
| Icco LLC | Current |
Accepting new patients | |
| Icco, LLC | Current | Accepting new patients |
Locations
598 E 13th Ave
Eugene, OR 97401
Phone (541) 636-3473
3675 Pacific Ave
#101
Forest Grove, OR 97116
Phone (971) 762-4611
3737 Shasta Way
Ste A
Klamath Falls, OR 97603
Phone (541) 883-2337
3400 Cooperative Way
Lebanon, OR 97355
Phone (541) 333-6605
1740 NW Goetz St
Roseburg, OR 97471
Phone (541) 672-4789
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 1039 | AK | |
| Family Nurse Practitioner | 363LF0000X | 592272 | CA | |
| Family Nurse Practitioner | 363LF0000X | RN2307349 | MA | |
| Family Nurse Practitioner | 363LF0000X | 201708984NP-PP | OR | |
| Family Nurse Practitioner | 363LF0000X | AP3112 | AZ | Yes |
Addresses
Primary practice location
57 Prospect St
Nantucket, MA 02554-2799
Mailing address
3265 Hillcrest Park Dr
Medford, OR 97504-7657
Phone (541) 210-8721
Other practice location 1
1740 NW Goetz St
Roseburg, OR 97471-1613
Phone (541) 672-4789
Other practice location 2
3737 Shasta Way Ste A
Klamath Falls, OR 97603-4982
Phone (541) 883-2337
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16809 | Other | CA | NP CERTIFICATION NUMBER |
| 500779563 | Medicaid | OR | |
| 592272 | Other | CA | RN LICENSE |
Other providers in Nantucket, MA
- Rebecca Cressy
- Jayne D Culkins
- Sunny Daily
- Daniels Strength and Recovery
- Kate Daniels
- Darcie Evans Licsw Counseling Services
- Roy M Davis
- Suzanne M Davis
- DB Pharmacy Inc
- DB Pharmacy Inc
All providers in Nantucket, MA · Family Nurse Practitioner in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.