Individual provider Active NPI

Alyssa M Cavalier

  • Licensed Practical Nurse
  • Portland, OR
National Provider Identifier
1740709658
Registry record updated Sep 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
201705709 Issued in OR
Practice address
6601 NE 78TH CT.
Suite A3
Portland, OR 97218
Phone
(503) 252-3949
NPI assigned
Sep 12, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 201705709 OR Primary

Addresses

Primary practice location

6601 NE 78TH CT.
Suite A3
Portland, OR 97218

Mailing address

6601 NE 78TH CT Ste A3
Portland, OR 97218-2823
Phone (503) 252-3949

Other identifiers 1

IdentifierTypeStateIssuer
028382MedicaidOR

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

LicenseStateTypeSpecialty
201705709ORMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505174400000",
    "number": "1740709658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 NE 78TH CT STE A3",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972182823",
            "telephone_number": "503-252-3949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 NE 78TH CT.",
            "address_2": "SUITE A3",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97218",
            "telephone_number": "503-252-3949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVALIER",
        "first_name": "ALYSSA",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-12",
        "last_updated": "2017-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OR",
            "license": "201705709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "028382",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.