Provider Demographics
NPI:1972814440
Name:MCINTIRE, ALICIA MARIE (PNP)
Entity type:Individual
Prefix:MISS
First Name:ALICIA
Middle Name:MARIE
Last Name:MCINTIRE
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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Mailing Address - Street 1:501 N GRAHAM ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-2008
Mailing Address - Country:US
Mailing Address - Phone:503-413-4300
Mailing Address - Fax:503-413-5301
Practice Address - Street 1:995 WILLAGILLESPIE RD # 100
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2186
Practice Address - Country:US
Practice Address - Phone:541-484-5443
Practice Address - Fax:541-687-5621
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2017-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR201050068NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201050068NPOtherSTATE OF OREGON